over america, we were horrified at the sights of benghazi and to know we're continuing to look and find the truth. so not just to look ba backwards and remember but look forward and put into place things that matter and would help those from the foreign service so when they go overseas to serve they will know if trouble cops we have their back. those are the things the ninth district were talking to me about and those are thing this is congress and this republican majority are putting a priority on. but while i was at home, i was also fortunate enough to get to talk to people who don't have time to focus on inside the beltway issues. in fact, they really don't look to inside the beltway to determine how they're going to get up and live each day. in fact, when i go home and visit constituents at hardware stores and pharmacies and businesses where americans go on a daily basis, i'm reminded

why my constituents elected me to be here. these are places populated by the people who don't ask for much from the government, they pay their taxes, pay their bill, get up in the morning, send their kids to school and go to work and come back home in the evenings and go to ballgames and go to parents' house and take care of their relative, take care of their neighbors, look after their school, look after their communities and what they want is just a government that leaves them a alone, that does what its supposed to do while they do what they're supposed to do. . they don't look to washington for their solutions. they look for washington to do what it was supposed to do as the founders intended, to be a form of limited government. a place that provides a healthy playing field. but it only provides it within the limited confines of the constitution and what the founders intended this organization and this government to be. when we look at this, they look around, they scratch their head, they say, when they see

washington not working, when they see it overreaching, when they see it getting into their lives and effecting their businesses and keeling -- keeping their business from expanding, by regulation that continues to tear down the fab ring of new business growth through our banking sector and other through ow manufacturing sector, and removing jobs at the expense of growing government jobs, they want to know, they say, doug, can washington be fixed? fixing the small things. sometimes it's not real vogue in this town. when we think about that, and when they ask me the question, can washington be fixed, i'm able to tell them that we can fix washington but it's going to take hard work and a lot of focus which the people of the ninth district of georgia know a lot about. and also a lot of our country in fact our country is based on hard work and focus and that's what makes this country great. first of all, we're going to have to start by fixing the small things. they sent us here to washington to fix it.

but we often get so focused on the big-ticket items of the day that we miss out on reforming the small things that are right in front of us, the things that can actually be fixed without a drawn-out partisan fight. and i say so -- see so many times, people say, what are you fighting about? and sometimes it's hard to explain. but there are some things we can do that we all agree upon. there's spending categories all over the government where billions of dollars are being wasted and not put to good use. in fact in my time here looking back from the reports from the government accountability office, you see the same programs listed as high risk year after year. we're ignoring billions of dollars in savings by overlooking the small things. i'm a big believer that if you do the small things regularly, and consistently they become habit and we as a government, if we would focus on the small things, if we focused on the things that mattered and the things that we could get agreement on, then the american people would slowly but surely begin to rebuild the trust that they have in this institution.

you see, one of the things i want to talk about tonight, i serve on the oversight and government reform committee. and i serve on a subcommittee of the federal work force, postal service and the census. now, i have to admit when i first signed up for this subcommittee, i thought to myself, what does this committee do? why aim on it? -- why am i on it? and then i began to look into it and i began to see what it actually works toward and one of the things that under its jurisdiction, whether it be the federal work force and the issues involved there or the postal service which effects every american. or the census. yes, the census. one small things that we need to -- thing that we spend money on is actually a pretty big thing, it's the census. using inflation adjusted dollars, the cost of the census that the government manages every 10 years has risen over 600% since 1970. if you look at this chart right here, you can see it says, since 1970 you can see the growth that has happened in the

cost of the census. the census cost just $17 per household in 1970 but it's almost doubled in cost every 10 years to the point that the 2010 census cost $115 for every household in america. now, i'm going to stop right here for just a second. and i'm sure that maybe if you were tuning in tonight you're going to say -- maybe you would have asked if you're watching this on another medium, and i'm sure a lot of you are asking right now, why is doug collins on the floor talking about the census? i'm hear because the census is a great example of how we can start to save taxpayer money by reforming the small things. this government has a spending problem. we spend money on more agencies and bureaus than most americans can possibly comprehend. all these pieces add up to budget problems that we face today and if we don't start fixing the small pieces now, how will we ever begin to

address the big ones? we spend almost $15 billion on the census in 2010. $15 billion. and if we don't start planning now, some projections indicate we could spend as much as $25 billion in 2020. $25 billion in 2020, a little over 10 years we're begun adding $10 billion and some think it could go as high as $30 billion. and the subcommittee of oversight and government reform committee last week, we heard from the new director of the census bureau about steps that can be taken to keep these costs from going up. however, the national academy of sciences has stated that it is possible that the 2020 census could cost even less than the 2010 version. with the technological developments that have taken place over the last decade we now have the ability to utilize the internet and mobile devices in ways that can dramatically cut costs. we know that the younger generation of americans is the

most difficult to obtain responses from when the census is issued. they are mobile, they're busy and they just have no interest in filling out surveys with a pencil and paper and mailing it back. there are much more -- they're much more comfortable using the internet than any previous generation. they're digital natives. it comes natural to them. luckily we have the ability to utilize the internet for responses in 2020. we already allow individuals to file their income tax returns online, implementing an online option for the census is a no-brainer. instead of sending out mlt approximately mailings and sending an hourly worker to gather the data, the census bureau can use the secure online survey. this also cuts down on the time it would take for someone to tribe a written respo -- try a written response into an electronic record. both of these measures had the potential to cut labor costs and most importantly to save taxpayer money. another way that we can encourage people to take part in the census is through incentives. at a cost of over $100 per

household, we need to consider creating incentives to reduce follow-up responses. improve the initial response rate by just 1% saves $85 million in taxpayer money. remember, taxpayer money. it's a word thrown around up here in washington a lot. but let's just make it very simple. taxpayer money is what's in your wallet right now. that is all that we have to run on unless we're borrowing it or printing it. we need to remember where our money comes from and why it's important to save it. whether it is through a small, targeted incentive or a partnership with a local school or community or something that we have not even thought of yet, beginning these discussions now will prepare us to implement them in time for the 2020 census. this is important. because many of you say it's still several years away, but i'm amazed, when i was pastoring i used to talk to people all the time who would find themselves in march and april and they could not understand why they were in debt. and i would often hear them make this statement, they made

the statement that said, you know, christmas and the holidays just snuck up on me this year. and i think to myself, it's the same time every year. how did it sneak up on you? and in 10 years we do the census every year. why aren't we putting our thought into it now and i'm glad to see that our committee is doing that. when we heard from the census bureau at a hearing, we also learned that some of the built-in cost to the census come from needing to ask questions requested by congressional committees. we have the power to add questions. but we should also consider using that same power to remove some. every question added to the census requires taxpayer funding. i hear from constituents often that the census and the american community survey are too long and too intrusive. while we can debate this issue at another time, there is no doubt that we should consider cost-save pog tensions of revisiting these questions asked because people do not have time to fill out long they find too

intrusive and too over the top and too overbearing, accompanied with that famous, if you don't fill it out, you're under a penalty of criminal law. we've got to get back to what really matters and one of the things is saving money and time. another area of savings we should be looking into is technology based on mapping software. as anyone who has had a smartphone recently can attest, the mapping technology in a small device is truly remarkable. a significant cost that adds to the census is when surveyers drive their cars through urban and suburban areas and then have to get out and walk to individual houses. often times they have to deal with traffic, depending on the time of day or the part of town that they may be in. as mapping technology is evolving, we now have the ability to maximize the amount of time census employees spend in traffic. we have seen this technology in action in the private sector. would you expect the private sector to know how to save money and earn a profit. that's exactly what they're in business to do. a company like u.p.s. has been able to develop software that

optimizes efficiency to their employees so they take as few left turns as possible. a driver might make three right turns to avoid making a left turn. while this seems counterintuitive, they found that it saves money. the employees spend less time sitting in traffic lights and are able to service more households per day. if the census can employ a mobile technology along these same lines, the bureau has the ability to save taxpayer dollars. now, i understand something. nog none of these cost-saving measures are truly revolutionary. none of them will shock people or cause a partisan divide. i doubt that our office will be flooded with constituent calls asking us to adopt them. but simply put, they're all commonsense measures that will save taxpayer money. the ideas have worked in other areas of government and have worked in the private sector. sometimes it doesn't take a revolutionary idea to be a good one. it often takes a group of leaders deciding to focus on an issue and keep pushing it until the process improves.

we have a chance to improve the census and to rein in the cost. as previously stated, we have the ability to save $10 billion in future taxpayer costs. as i said earlier, the big things will always work themselves out. we can even run from crisis to crisis up here and people will focus on the big things and we will continue to work on those because they matter. but it's the time we gave -- but it's time we gave some crucials to the small things. when we add the small pieces together we start to reduce the deficit and get this country back on a solid financial ground. this is what matters to the people back home. this is what matters when they come up to me in the grocery store and they talk about washington being broke. they want to know how it affects them at their tables, at their homes and with their families. when we start focusing on the small things, the big things get in perspective even clearer and we're up here doing exactly what we're supposed to be. and the republican majority is

focused on limited government, focusing on jobs and getting america back to work again. with a government that does what it's supposed to do and gets out of the way. and with that, mr. speaker, i thank you for allowing me to speak on this subject tonight and i yield back. the speaker pro tempore: the gentleman yields back. for what purpose does the gentleman from oklahoma seek recognition? >> mr. speaker, i send to the desk two privileged reports from the committee on rules for filing under the rule. the speaker pro tempore: the clerk will report the titles. the clerk: report to accompany house resolution 351, resolution providing for consideration of the bill, h.r. 687, to facilitate the efficient extraction of mineral resources in southeast arizona by authorizing and directing an exchange of federal and nonfederal land and for other purposes. providing for consideration of the bill h.r. 1526, to restore employment and educational opportunities in and improve the economic stability of

counties containing national forest system land. while also reducing forest service management costs, by ensuring that such account counties have a dependable source of revenue from national forest system land to provide a temporary extension of the secure rural schools and communities self-determination act of 2000 and for other purposes. providing for consideration of the bill h.r. 3102, to amend the food and nutrition act of 2008 and for other purposes. the speaker pro tempore: -- the clerk: report to accompany house resolution 352, resolution providing for consideration of the joint resolution, house joint resolution 59, making continuing appropriations for fiscal year 2014 and for other purposes. and providing for consideration of motions to suspend the rules . the speaker pro tempore: referred to the house calendar nd ordered printed.

the speaker pro tempore: under the speaker's announced policy f january 3, 2013, the chair recognizes, mr. fortenberry for 0 minutes. mr. fortenberry: mr. speaker, this morning, i met with a group of citizens from nebraska, called the nebraska breakfast, a 70-year tradition we have here where the house members and citizens get together. it's a wonderful way to welcome people to washington and what we do as a delegation is talk about the issues of the day and hear from our constituents as well. i thought it might be important to review a few basics, some of the fermnolings, some of the language that we throw around with great ease as often i think are disconnected from people out

there, words like continuing resolution, affordable care act, sequestration and debt limit. and the reason i point this out, there is a convergeance of these factors that is creating the great debate in this diagram ave . continuing resolution, what does that mean? each year if it worked in a proper fashion, the president submits a budget to congress. congress can take that budget out or not. the house passes a budget and the senate passes a budget and the two reconciles and the appropriations committees go to work on various aspects on funding the government whether it's the defense department, military services, transparency, financial services, agricultural support and the rest of the so-called appropriations bills.

the budget sets up a fence and the appropriations bills divides out how that money is to be spent. that is an ideal world. when congress cannot get a budget agreement between the house and senate, we come to the end of the fiscal year which ends this september, and we have to figure out a way to fund the government going forward or else it shuts down. when the government shuts down, there is the potential for planes not to fly and veterans not to get their services, not a proper way to govern. not good for the country to have this uncertainty looming out there and we want to avoid a government shutdown while moving forward on fiscally responsible policies that return us to regular order here and try to get back in place a system of governance that gives some proper planning horizons for the

communities at large out there across america and brings it back into an orderly process here. so, if we are not able to pass a budget, the continuing resolution is a vote by both the senate and the house as to how to move forward it in a temporary fashion or long-term fashion based upon what current government policies are. each year, the frustration, each year as of late, we have been going through these difficult processes, particularly through the appropriations process about which programs are important, which are necessary public policies to help bring essential services to the american people, and which programs are older, no longer effective and should either be reduced or eliminated. we have gone through a number of those processes this year, but because of the disagreements between the two bodies, because of the deep philosophical divide

in this chamber, we have not been able to find a resolution that gets us to what we call regular order, passing appropriations bills under a budgetary framework. so now we are faced with a continuing resolution, the decision as to how to fund the government either a short-term, few months, few weeks or a few days. the continuing resolution is pick up government where it is and move it forward, basically spending the same amount of money we did last year and not getting the reforms. it might come to that but that is unfortunate way to govern and adding sin civil in the american people's perspective as they watch the divide play itself out on the house floor and seemingly not being able to get anything constructively decided. let's get er done.

let's find a proper and balanced way to appropriately reduce spending, perhaps the right type of tax reform to get the fiscal house in order. why is this important? well, we have a $600-plus billion deficit this year and year after year we have piled up debt. there is $17 trillion of debt. by some measures, the size of the output of the entire economy. it's a real red flag. and that's why it is so imperative that this body strife to work together again in a constructive manner to figure out the right type of spending and tax policies that deliver essential services, reduce the overspending, increase accountability and effective and smart government and delivery of policy while also having a fair and simpler tax code. that should be the objective.

but unfortunately the system is working very disfunctionally and going to be faced with decisions how to fund the government in the short-term so it doesn't shut down. complicating that this year is the whole debate, about the future of health care in america. couple of years ago, the affordable care act was passed and i did not support it and now known as obamacare. we need the right type of health care reform in our country. health care reform that is going to improve health care outcomes while reducing costs. instead what we have, and i think, mr. speaker, most americans are beginning to see this because it is hitting and hurting them. instead what we have in the new health care bill is a shift to more unsustainable costs and erosion of health care liberties

and significant amount of americans are experiencing not affordable care but escalating costs of their premiums. there are some components that are reasonable and as we move forward we should retain them, like keeping kids on health care until the age of 26, removing caps where a family would cap out. the family has to find another job and insurance provider creating greater duress. the problem of dealing with pre-existing conditions. there are a number of americans who are priced out of the insurance market who could not find affordable quality insurance and that is a real crack in our market system. so that is necessary that public that, but what we have gotten instead is a massive turning over of our

entire health care system that is creating havoc. prices are going up. people aren't sure whether they can keep their doctor or health care plan. some people are experiencing unemployment as companies aren't expanding or are reducing numbers or getting under the threshold, and some employees are having reduced hours. this is a very big problem. and then another component of this is the president and the administration have exempted for certain entities, recently, the implementation of the business demand that they provide health care, has been delayed. and it's really not fair, because individuals are saying if you can tchay the businessman date, the corporate mandate, why not the individual mandate. the fullness of the obamacare, the affordable care act is coming into force. so this is colliding with our

budget area discussion and creating dynamics as we end the fiscal year. the other aspect is called sequestration. couple of years ago we were this a similar situation where we were faced with raising the debt ceiling and i'll return to that washington phrase in a moment, or not. and a special committee was set up to review the tax code and review spending and were going to come up with a process there was a fair and balanced approach, but that supercommittee failed, but the incentive for them to act in a constructive manner was something called sequestration, which is the implementation of automatic budget cuts primarily affecting the defense of our country in what we call nondefense discretionary spending. nondefense discretionary spending is everything else that the government does other than

defense, veterans and retirement and health security programs. basically, social security, medicare and medicaid. a third of the entire budget is what is being affected by sequestration and many members of congress have seen the furloughs in their district and cutbacks inviteal programs. there is widespread support particularly where i come from to make sure we have the right spending reductions while important delivery of smart public policies and services. we have to do this in a smart manner and sequestration does this. and clumsy way to do this is not using discretion. not taking the best judgment through a normal process of considering a budget in an appropriation bill and saying, that program may have been good but no longer fits modern needs, let's get rid of it and save

that money and bring down spending and apply it to something new. that is what sequestration is doing because that supercommittee failed to meet its goal through automatic budgetary reductions put in place. they will continue unless again we can come to an agreement as to how we replace sequestration with a more prudent form of spending reduction that will recouple. let me talk about that fourth washington phrase, the debt ceiling. we never used to hear much about this. the debt ceiling is something that came and wept. congress has to give the authority to the president to go out and borrow money and usually that was automatic. because our debt has gotten so large, so severe at $17 trillion, most members of congress are saying this is so

severe that it demands creative thinking and bold resolve. or else we will undermine not only our economic well-being but our national security. how so? what does $17 trillion in debt mean. we are a people that self-governance. this debt is not sitting out there as somebody else's problem but america's problem. if you divided it all up between every man, woman and commiled, every one of us would have to write a check for $53,000 in order to pay off the current debt. that doesn't even consider the projection of debt in the future, based upon the way in which current spending programs are constructed. if we take the present value of the future obligations of programs as they are now written, the debt would so accelerate that each person in america right now if nothing

changes would owe $300,000. mr. speaker, there are seven us in the family, obviously i can't afford a check $2.1 million, nor can most americans. something has to change and it will take bold resolve and constructive commitment to fair and balanced outcomes both on the spending side both on the tax code ledger side. if we don't do this, mr. speaker, what are the consequences? we don't deal with this debt successfully. and by the way, it can't be done overnight, it's too big. and it would be too disruptive, but we have to set a pathway which we are committed to reduce the debt. turning this battleship around. the consequences are this.

a form of taxation, future taxation. we are forcing the children of the future to pay the way we are living right now. it is unfair. secondly, this high level of debt, a lot of it is held by china. what does that mean? that is a shift of the assets of what we own into the hands of other people. now we get all worried that china is undertaking a military expansion. we have sent a heck of a lot of manufacturing over there and a lot of our economy over there. they make the stuff, we buy the stuff. they have the cash, we run up debt. they buy our debt. very dysfunctional marriage. the consequencesr over time, that is a shift of what we own in this country into the hands of a place like china. and where does that money go? there is a ruling elite that is

doing well. a hybrid capitalist communist system that isn't interested in human rights and doesn't seem to be advancing. this economic revitalization you would think would focus on human rights and human dignity but has empowered a wealthy elite and be put back into military infrastructure buildup. our debt is a national security problem. because we hear that the chinese, for instance or -- expanding their navy, nuclear arsenal and what is our response? we'll send more ships into the pacific. mr. speaker, there is a response that needs to be had and we need to work diligently and quickly and boldly with clear resolve, idealy in a bipartisan prop.

this isn't about politics, mr. speaker. this is about principle. this is about participation in the future welfare of our country. regaining our balance, regaining our strength. transcend the bipartisan divide. we will have the debate of what is the right type of tax, but we should all be committed to getting to this goal to quickly reverse this trend which has vere national security consequences. . we have a very expansive liquidity problem going on right now. basically buying up our debt and the consequences over time could be an unleashed -- further unleashing of inflationary impacts which is a form of taxation. a regressive form of tax fashion -- of taxation. it hits the poor the hardest.

those who are on fixed incomes, seniors the hardest. it is grossly unfair. f -- so that creates a further form of taxation on those who are least able to handle it. so this is why, mr. speaker, this debt problem is so severe. we're bumping up in the near term against this debt ceiling limit. again, what does that mean? congress has to give the administration authority to borrow more money. now, the last time we did this, we actually reduced spending by more than the amount that we borrowed. that was the plan. again, trying to get to this in a man that are does not disrupt, but -- manner that is not disruptive, but reduces the spending in a necessary fashion by more than the amount that we continue to borrow. so, it's a slow walk toward a better situation. we may end up there now, i don't know. but this is one of these dynamics that's sitting out

there along with continuing resolutions, the future of health care in this country called obamacare. the sequestration, dealing with these automatic cuts if we don't figure out a constructive way to budget. and to appropriate. and then the debt ceiling in which we have to have a plan to basically continue to pull down this very, very large burdensome debt and all of its economic as well as national security consequences. mr. speaker, we must do this and we must do it now. so, i would urge all of my colleagues, let's transcend the partisan divide here. we're going to have differences. we all come from districts with particular perspectives. we have different philosophical ideas of how to approach government. some people want more investment at the federal level. those of us who believe in sub sidyarity or those closest to a problem or opportunity should be empowered to solve the problem or seize the

opportunity, federalism as it used to be known. but that has been the robust way in which america gains such economic prowess in the world. and was a leader and continues to be a leader for so many people who desire the nature of a system like ours, that is rooted in this cultural ideal that each person has inherent dignity and rights and also has a responsibility, even responsibility for government. so, mr. speaker, we're going to have quite a bit of drama, i'm afraid, in the coming days and weeks. let's hope it doesn't add cynicism to the deepening cynicism toward our constitution. people of america have en-- institution. people of america have entrusted us to represent them. to make judgments on their behalf. i think most people in america want something constructive done. something that's fair. hat's not done in an emergency

, 11th-hour scenario. that doesn't disrupt well-being. that takes a little bit longer view. it's pat past the politics of the movement, takes a longer view as to what's right and good for america. mr. speaker, the people who me behind us, who sacrificed so much to build what we have, don't they deserve our best? ment they deserve a commit to the higher ideals? because this -- our economic well-being is tied to our ability to work constructively and creatively together, to get this fiscal house in order, to get it on the right track, to appropriately reduce spending while also delivering smart public policies that are effective in helping people cross this country, that revitalizes our economic strength, that takes the duress off of communities where people can't find jobs, can't find work. that creates a fairer tax code,

that's less convoluted, a little bit simpler, where you don't have to have an army of lawyers and accountants to wade through it in order to figure out ways around it. that's what we ought to be focused on. that's what we need to get done. that's what i think our people are demanding from us. mr. speaker, i appreciate the opportunity to share these thoughts with you and my colleagues and with that i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the chair will now entertain a motion to adjourn. mr. fortenberry: mr. speaker, i move to adjourn. the speaker pro tempore: the question is on the motion to adjourn. those in favor say aye. those opposed, no. the ayes have it. the motion is adopted. accordingly the house stanledses adjourned until 10:00 a.m. tomorrow for morning hour debate.

has the government done this. we aim for that to happen. we aim to stop obamacare before it causes cut -- cost one more

out-of-pocket expenses for a family one more dollar. that will continue as we negotiate the debt limit with the president and the senate. in the coming weeks, we will unveil a plan to extend our nation's ability to borrow while delaying obamacare and protecting working class -- middle-class families from the horrific effects. will also focus on a path forward, tax reform, the keystone pipeline. and a variety of other measures designed to simplify our tax system and get the economy going, from the middle class working people of the country. , we house republicans will not ignore the problem of our debt or the problems facing the working middle class of the country. we hope and ask this president finally engage with congress and

work with us on behalf of american families. >> we all join with the comments the leader made. .e just walked out all of you stay outside to see, what is the seal, what does it look like. i have not watched our conference -- us be so united. you will see big excitement .oming through the week the excitement is that a united conference going after the battle we are always willing to wait. now we will look forward to the senate waging with us. the president laid out different portions of health-care bill not prepared for the rest of the nation. -- it is not just us who talk about it. it is union leaders, as well. we think the individual matters more.

that is what you will see coming forward out of the house. >> i would like to join in offering condolences to the families who lost their loved ones on monday. our hearts and prayers continue to be with them. it was a terrible day here in our nations capital. also on monday, we heard from thepresident regarding economy. he said what we need to -- we need to work together to create jobs, grow our economy, and band opportunity. i would like to remind the president is that that has been our goal since day one. it is unfortunate that many of the president's policies are making it harder on americans across the country. americans continue to have a tough time finding a job in the economy. they are seen their premiums go their health insurance.

it is harder at the gas pump. 1000 days plus that gas has been over three dollars a gallon, the first time ever. at the grocery store, it is harder to pay the bills. republicans are focused on policies to make it easier to create a crock -- a climate, a stronger economy for america, so americans have an easier time finding a job, paying their bills. numbers. not just these are real people's lives. policies we debate make a difference in people's lives. we are committed to work with the senate where we can to move policies forward that will make a positive difference and get people back to work. >> the president said earlier this week that the economy is not where he would like it to be.

something my constituents are very well aware every time they go to the doctor and go to the grocery store and fill up their automobile with gasoline. to be.ot where it needs after five years as president, we are hoping he will turn to --gress and work with us to improve the economy. the unemployment rate was slightly down. people have all but given up looking for work. is more important statistic the work force participation rate is the lowest it been in 35 years. the lowest since 1978. while we stand ready to work with the president on a number of issues articulated already on the health or law, to keystone, tax reports -- tax reform is something we have been working on for several years now. we have the highest were brick

tax rate in the world. to pursuete we refuse tax reform we are incentivizing businesses to take their jobs offshore. that is the wrong answer. we have been working very hard for smallfe easier businesses by lowering the rates, eliminating the loopholes only the wealthy take advantage of. we want to to -- put more money in hard-working taxpayers pockets. we stand ready to work with the president and hope you will engage reforming our tax code and getting the economy back together. >> thank you. i appreciate some of the comments made by the president and vice president this week regarding the economy and necessity to do infrastructure jobs. the port.at

there has been one infrastructure -- process, because of the -- political reasons, has been ignored. by theon taken administration. i'm talking about the keystone xl pipeline. tomorrow marks an interesting anniversary for small businesses. it is the fifth year anniversary of the keystone permit. what is particularly interesting about the administration ignoring the infrastructure and jobs and economic driver bill and project is that, shortly into the president, did sign and the state department did recommend a cross-border permit is a highflying carrying oil into the united states.

not have ant did problem with the alberta clipper pipeline delivering oil into the united states and crossing the border until he be -- it became an environmental issue on the keystone pipeline. , because of politics, as -- has the president refused to act on the permit. our leadership is discussing and contemplating putting the keystone pipeline, and whatever opportunities we may have, the debt ceiling, and continuing resolutions, and i appreciate our leadership continue to focus on this type of job bill. you did not want to attach a obamacare -- funding obama. -- funding obamacare. i know it has not been easy. at this point, have you lost control? >> we have a lot of give urgent opinions in the caucus.

the key to any leadership job is to listen. i was here during the newt gingrich era. he had a plaque in his office. a management model. listen, learn, help, and lead. we listen to our colleagues over the course of the last week. we are going forward. [indiscernible] www.c-span.or the fight over here has been one. the house voted 40 times two change obamacare, repeal it. it is time for the senate to have this fight. i will not predict what the senate will or will not do. [inaudible]

whatwill not speculate on the senate will do or not do or what we will or will not do. it is very premature. the implications and the ramifications of a possible government shut down [inaudible] nothere should be conversation about shutting the government down. that is not the goal here. our goal here is to cut spending and protect the american people from obamacare. it is as simple as that. there is no interest in our part on shutting the government down. >> jay carney was asked about the house republican proposal for a short-term spending bill. >> now that we have a clear sense of the trajectory of the

, does the administration think the fact they are probably not going to vote friday, does that make the possibility of a government shutdown more likely? >> i hope not. as i think we saw in the houseing today, republicans have decided to pursue a path away from the center, away from compromise, in on a piece ofg legislation that they know will not become law. one sobering paragraph i read in of story was that members both parties are becoming increasingly worried that the fact a faction of the house of

representatives, the house republicans, is driving this thing in the wrong direction could putting us closer -- bring us closer to an unnecessary shutdown of the government. a sicks has responsibilities. one of them is to fund the government, the operations. it is not to attach ideological the kinds ofo bills that ensure the government does not shut down and that we do not inflict another unnecessarily wound on our economy, just as it is continuing to grow and create jobs. what has become more and more is that the leaders of the republican party in congress may want to avoid a shutdown. it may want to avoid, even

worse, a default. the party,embers of especially in the house, who seem to embrace the prospect. the irony is they are doing it in the name of trying to defund or delay or defeat in some other to provideesigned access to insurance for millions of americans. it is already providing tangible benefits to 2 million americans. a law that, when implemented, closensure that at least to six and 10 uninsured americans will have the capability of buying insurance for less than $100 a month. that law was passed by the house, the senate, signed by the part -- by the president and upheld in the supreme court.

in order to revive the political battle, some members of the republican party in congress seem to want to shut down the government and maybe have, for the first time in the history of this great country, see the united states failed to pay the bill it has already incurred. this is a problem. we have to be clear about the fact there is a majority in a member of which is the president of the united states, every democrat on capitol hill, and many republicans on capitol hill, who do not want to see the government shutdown, who do not want to see the pain inflicted that a shutdown would put on the and will not negotiate over the ideological aspirations of a small group

and unfortunately not that small group, but a faction within the republican party in the house. firstn helen taft became lady in 1909 9, 1 of the first things she did was address having cherry trees planted. in the early 20th century, it was a mess. the japanese heard about her interest and decided to give 2000 trees to the united states in her honor. everyone was shocked. the trees were very tall and older. would haveded they to be burned. president taft himself made the decision. the japanese were very accommodating and understanding and decided to send 3000 trees. we still have a few of. >> watch our program on helen taft on our website.

we continue our series live next monday as we look at first ladies. october 1, state health care exchanges will begin offering health insurance with subsidies for those earning below 400% of the official poverty line. a house committee heard testimony from state officials putting those exchanges into operation. subcommittee on economic growth and health care. this is 45 minutes. deserve an effective government that works for them. our duty is to protect these rights. i was solemn response ability is to hold the government

accountable to taxpayers because taxpayers have the right to know what they get from the government. towill work tirelessly bring the facts to the american people and bring genuine reform. this is the mission to the reform committee. in the past month, i have whoonally spoken to a dad told me his high school graduates on is finding it difficult to find a job who will hire him for more than 24 hours. i spoke to a mom who brought me her late twentysomething sons paperwork which notified him his health premiums will decrease to just over $800 a month in january. i spoke to a family struggling with their family business because they cannot afford the mandates but cannot afford to sell the business they work so hard to build. paperwork which notified him his healththey prevent anyone else m entering high-risk pools. no one disputes the concerns for the u.s. health care system or for obamacare.

the rising cost of health care was crowding out other items in family budgets. obamacare was designed to fix three problems -- reduced the cost of medicine, provide universal coverage for every american, and increase the polity. -- quality. americans were told, if they like their doctrine insurance, they can keep that. after decades of work, union members are furious in the changes of health benefits and the traditional 40 hour health week. the law passed three years ago limitation, the of has been mired by one problem after another. they missed approximately half of obamacare is required deadlines. compressed time frames and a lack of clear federal requirements -- a major i.t. challenges to hoping -- changes in enrollment. obamacare's employment -- employer mandate -- a unilateral

delay by the ministration -- the exchanges will have more difficulty verifying whether work.ill have -- at this exposes taxpayers to a risk of civilian spending on subsidies. for those who receive them, a tax at the end of the year that will be a surprise to them. everybody ok? the administration only delayed the employer mandate. individual citizens are still liable. just businesses are no longer liable. state leaders across the country have complained the administration has not adequately responded to their questions and concerns. the new states have part-time legislatures only in session during the spring, the failure to issue timely guidance to implement the law and better protect its citizens from its harmful aspects. multiple state officials involved are preparing their respective states for the start of obamacare.

multiple witnesses. lieutenant governor of kansas, who is also a physician. .lorida state representative and attorney general for the state of south carolina. yesterday, the democrats on the committee threatened not to participate unless we provided eight witnesses. normally, the minority party only elects one witness. even in the majority pollack -- you only had four. we do not want members of this committee -- willing to do oversight work to walk out and fail to hear the serious struggles fates are -- states are expensive because of obamacare. we made the unprecedented accommodation to let them provide the same number of witnesses as the majority. we should listen to their concerns. should find solutions.

one area we will explore today is the sister programs. attorney general wilson from south carolina sent a letter to a secretary on august 14 asking questions about the outreach program. the in ministration has not yet responded. i spoke yesterday with health care leaders in my own state. they said they cannot get answers from hhs. they still have no idea what is happening, and we are only days away. i would like to introduce a theseinary staff report. findings were produced or the committee.

a large number of americans fall big into identity that. identity the theft. the administration decides to leave the responsibility to the district. result the federal government will not be able to leave a list. they allow them to they their employees. we have multiple issues. needs oversight.

ask if itonable to meets the requirements. >> this is not a hearing. this is the inner. -- is theatre. some of my colleagues did not like the way the election turned out. it's time to take the makeup and costumes off and get real. rewrite, noe no

matter how much you would like to rewrite the ending. states the elected officials are not subtle about it. they don't even try to mask it. take the member from georgia, .ho was caught on tape lay the video. >> the problem is obama care. we are doing everything in our power. a navigator, which is a position

in that exchange, has to be licensed by our department. [applause] care law says we cannot require them to be agents. >> he said he was doing everything in his power to be an obstructionist. his insurance department would make up that test requiring pass.tors to

the only justification for the new requirement is it helps implementation of obama care. they are doing everything in their power to be obstructionist. he is no particular ax or it -- expert about implementation. he released a bill recently about appealing obamacare, which was published by the american exchange council. not every american tolerates these tactics. commissioner

struggled to implement the affordable care act. they returned a grant to help the state set up exchanges and called the affordable care act an abomination. senators mccain and coburn have criticized their colleagues for working to bring about a government shutdown just to stop funding. senator coburn called it dishonest. this is a concerted campaign to but itople health care, is being orchestrated by entities and financed by billionaires. i believe in the importance of congressional oversight. it's our job to make sure the laws are carried out effectively.

this committee is not interested orgetting to the facts identifying improvements or technical fixes. this committee has decided to undermine the law. mr. chairman, this effort has absurd. theater of the while i appreciate that they are trying to convince the audience there is some balance to the script, your play will not make it to opening night and will be relegated to theatrical failures once the show begins to run. of ae this is the end charade to undermine a law that has been found to be constitutional, and i would like to remind my colleagues we are then to uphold the law and constitution, and that is a duty i take seriously.

it's time we do our job. want to welcome the senator from south carolina and other senators. thank you for joining us today. but i would like to recognize the chairman of the subcommittee is opening statement. >> thank you for putting this together. let me say in response to the last statement, everyone knows this law is not ready. they said, fix it or repeal it. jordan --ican jim they said it was a train wreck. howard dean said it was going to

lead to rationing of care. they said it is going to fundamentally hurt the work week, which it did. even the president knows this needs to be delayed. it was unpopular when not one single republican voted for it. it is even more unpopular now. this is unbelievable. we are going to hear from people in the frontline today who know how hard it is to try to implement this legislation. , seventh-largest state, hasone single navigator

been trained by the ohio department of insurance, and we are 13 days away from the exchange starting. is going to this work well? you don't think this needs to be delayed? of course it needs to be delayed, and the americans need to understand that. we are asking our colleagues to recognize that fact. this is about highlighting that fact. read my statement. i just reacted to what we heard before. this is as clear as it gets. i have never seen something this obvious make this much common sense and have that much opposition. unbelievable. ask for hising to opening statement. >> thank you for calling this

hearing. this country some state legislators and other public officials are obstructing .he affordable care act just this week florida governor rick scott issued a direct of banning grantees from operating department. health this is particularly obstructive because county health department are precisely where floridians with questions about health care will turn. strippedt also florida's insurance commissioner of his ability to review insurance rates and protect consumers from unfair or hikes.ve premium the affordable care act requires insurance companies to justify any increase of 10% or more. 6.8 millionis saved

estimated one point $2 billion in health insurance premiums. this is working. this represents a state government openly obstructing implementation of our affordable care act. don't havesses concerns about implementation. one witness, state attorney alan wilson, works under nikki haley, who said, when it comes to obama care we did not just say no. we said never. we are going to keep fighting until we get congress to defund obamacare.

bobby jindal says, we do not think we should implement obamacare in louisiana. we are going to fight it. our constituents deserve better and one constituent is here, a resident from my home state. you are here, will you stand up? here at her came own expense, and she is here to her compelling story, but i will tell you right here. it is a written statement, but the majority has not allowed stacy ritter to prevent her statement, but i am going to read an excerpt.

>> we have been unprecedented number of with -- we have an unprecedented number of witnesses. they were selected by the minority. there were four witnesses we selected. we have the largest have a we have ever had, all previous witnesses were select it by the minority, so i hope the gentleman was mistaken. here's what stacy had to say. was a rare disorder, and she says, things to this, the girls will no longer be against if i lose

or switch jobs. my girls can remain on my insurance until they are 26 time.old, giving them permission toask record.his into the nearly 10% of dental maintenance report they were unable to see a doctor due to the cost. families saw their health annualce increase, an increase of $13,229. of those who do have health

insurance, 53% are covered by their employment public programs . five percent of residents purchase individual policies. million, a 11% of the population uninsured. aresylvania's children uninsured at eight percent. nonelderly adults younger than a rate ofnsured at 32%. a quarter of the nonelderly lacksic population insurance. nonelderly blacks are uninsured .t a rate of 17% -

over the next six months, as the health exchanges stand up, pennsylvanians like stacy ritter will finally be able to get the help they need for their families. our job is not to interfere. i yield back. >> i recognize the chairman for a segment. >> i want to thank the members for this hearing. a large panel, and i look forward to getting to that panel. old expression. people will say, some of my friends are for it, and some of them are against it, and i want to be with a friend. i have never said, let's eliminate all obama care without

viable replacements without all the things the affordable care act chose to do. the affordable care act, because i felt there were many things that were or lopsided. i think every member would say there were problems with health obama came president into office. the affordable care act was designed to tackle certain problems, many of which we agree with. people find themselves unable to leave a job. the college graduate or returning veteran not eligible for retirement but unemployed and out of the military trying to figure out where he or she is going to go to get health care. there were many groups falling ofough the safety nets

health care. america's problem is not that we healthme of the best care. it is that we have expensive health care. attacking the real problems of our health care costing more than any first world nation is something we should work on. something i am taking exception to, not on a personal basis, but she said this law is the way it is and nothing is going to be changed. that law happens. the affordable care act mandates every member -- every staff member is to be thrown off the

federal workforces health care , put into an exchange, and not reimbursed. the affordable care act cuts the benefit for people making as little as dirty thousand dollars -- $30,000 affers year as the staffers on the hill. fixed. we cannot have the men and women who would members ofve congress find themselves working for a deadbeat employer. that israel. it's in the act. maybe we can say we have to fix it, but it's there. is an implementation that has a lot of bureaucracy, including exchanges. the idea was that states would come together and want to have exchanges and subsidies that

came with it. i believe we have seen a betweente disagreement states that did not want to have a limited subsidy and leave them holding a bag with all regulations that come with the program. this committee has held a series of hearings. a series of hearings on the implementation problem, databases, privacy, and so on. not to kill an existing law. they are to make it clear if they are to go into effect, it can go in a time when it can be effective. nothing can kill obamacare faster than a series of mistakes , losses over denial of care, or huge cost overruns. i am not one of the people who said, i'm going to kill obamacare, i am going to attempt

to delay or deny, but as chairman of the committee, we have seen serious problems. hopefully by putting all seven we give anel, opportunity for people who have concerns or those who admit we are ready to go live in a couple days to have an appropriate debate. member whenranking he made the choice to choose people from responsible positions where they are looking and whether implementation will be done properly on time. the opening statement that if the president wants to delay one part of the mandate congress has to ask, are we ready to go live?

we understand some parts of the affordable care act are already implemented. it is a question of implementing that hash a database not been tested but is supposed to go live with all your personal information transfer with the irs and your health care information added on a daily basis. should eatething we concerned about, so i joined the ranking member in welcoming this large panel of distinguished agreeduals who do not with everything but hopefully understand we have to get it right, and if that means changing parts of the law, so be it. work together to make it an affordable care act in every way we can.

thank you for the indulgence. i yield back. >> thank you, mr. chairman. wordsery heartened by the of the committee. i want want to thank all of you. i want to remind all of you of something we may have forgotten. this is the law. it has been passed. soup judge roberts of the rheem court said it was constitutional. law, and every two years every member of this committee, we put our hands up, and we say we are going to uphold the law. start.where we

i am so appreciative of what the but the 41st said, times we have voted on this, it was not to replace it. it.it was to kill to kill it, 41 times. you.t to thank i want to thank the chairman of the committee. they are elected officials from south carolina, florida, and louisiana. after serving as speaker pro tem of the house, i want to thank all of you, and i appreciate your service. members are proud to implement the affordable care act even in the face of obstruction coming directly from their own governors.

trying to implement the law. unfortunately, there is an effort by some republican officials to strike the affordable care act. these officials have openly -- it is not a secret -- ledge to fight implement -- pledged to fight implementation and adopted legislative and regulatory maneuvers to sabotage the affordable care act. that's a fact. led thesethe chairman organizations, demanding they turn over huge amounts of documentation to a committee on energy and commerce. he said, "this is intimidation another effort to sabotage."

not replacing anything, trying to kill it. some say they have taken a page from the same label. generalginia's attorney sent letters demanding answers to questions. they subsequently returned recently thousand dollars in grant money it had applied for and won. the problem is there are tens of whoions of people desperately need the affordable , and as oursucceed y, i want youtifi to tell them what happens to the people of your state to our sick and cannot get care, and they need members of congress to help do their job and see affordable

oversight. would you stand up, lori? a resident of virginia and the victim of a stroke. you may be seated -- as well as other health problems. she is here on her own dime. has what insurance companies call a pre-existing condition, and when the chairman talks about the good part of the law, one thing to keep in mind is you have to have the whole law to make it work. >> will the gentleman yield? >> i want to finish my statement. i want to talk about this lady who traveled here who was ill. she traveled here to present her story to congress. leave my"i decided to job to pursue my dream of owning my own business.

later that year i needed emergency gallbladder surgery and suffered complications. my insurance rescinded my coverage and left me with $50,000 in medical bills in my first year in business. if the affordable health care act had been in place it would dropran against the law to me from coverage. i am looking forward to the opening of the health insurance marketplace and the availability of a new tax credit that could potentially make my health insurance even more affordable. i am also appreciative of the fact that i no longer have to worry ever about the a denied coverage because of pre-existing -- about being dean i'd coverage because of re-existing conditions." coming,o thank you for for telling personal story of your life. you speak for millions of americans, and i asked that the complete

statement he entered into the record. truth is nobody believes this hearing was intended to help make the affordable care act work that are. are -- work better. republicans have taken more than 40 votes on the house floor to replace itacare and with absolutely nothing. everybody knows what this hearing is about -- trying to .nd obamacare -- end obamacare they will to shut down the affordableunless the . they want d funded to go back to the days of discrimination against people with pre-existing conditions. i have said it before, and i will say it again.

do better. there are things we can do to improve this. be hard, but this is america. we do hard things all the time. people's lives depend on it. >> the gentleman talked about the law, implementing the whole law. was the president upholding the did this toen he big business? delayd, -- when he gave a to big business? he knows what the president was trying to do -- >> would the gentleman -- >> are you going to let me ask the question?

i said before, this is hard. if they could not get things accomplished, the president gave them that we way. a lot of the problems happen because we were trying to pass it. the chairman of the committee is right. you are right. there are things that could be better, but that doesn't mean we throw it out. people will die. he will literally no -- literally die, and you know it. he specifically said the whole law. speciald not give a .ispensation for big business

>> i know we can have witnesses who can deal with the challenges everyone is concerned about, so i hope we can get to it. with the ranking member in one sense. this is an important hearing. from both sides, i look forward to it. wewe look forward to that as try to figure out what are the real effects on the ground. i recognize our panel today. the honorable jeff callier is the lieutenant governor of kansas and also of physician.

qwest we normally hear all of the witnesses. are we not going to do that today? >> we are. we cannot have a good hearing without a good swearing. wilson is thealan attorney general. we have the secretary of health and hospitals from louisiana, the state senator from florida, and matthew hudson is the state representative from the state of florida. all witnesses will be sworn in before they testify. raise yourou to right hand. do you solemnly swear the testimony you are about to give will be the truth and the whole truth?

seated. e we will have good discussion. please limit your testimony to five minutes. you will have a clock that will start as soon as you begin. when that is lit up you are alive. with the microphone get as close as you can. we want to make sure we hear every syllable. >> thank you, mr. chairman and ranking members. my name is jeff callier. i am a practicing physician who day hasred -- who every operated on people without insurance. this is something that is very personal to me. kansas isstates, facing problems with the affordable care act. a drag on businesses.

a gallup poll suggested 41% of business owners said they were willing to hold off on plans to hire new employees because of the affordable care act, and in kansas that trend is no different. the biggest concern i hear is the acartainty of what will do to small businesses. it affects businesses such as mine. i am a sole practitioner. yesterday we had to sign a contract for $3400 to rewrite compliance manuals to fit in with the aca. all it does is continue the same requirements as before, but we have to have a new documentation. it does not change what we do, but it costs us new equipment, new jobs, and taking care of our patients. you are going to see this in a lot of different laces.

-- different places. another man says he needs to avoid the mandates that would require companies with more than 50 employees to meet the requirements. bergmire'sier's -- situation is not unique. this is damaging to everyone, especially the middle class. issues ofother interoperability. our state is significantly advanced, and we have a very good, very strong working relationship with cms and a very positive one. as recently as september 6, i sent my testimony. there are a number of technical

updates that keep disrupting the completion of this. it appears there is going to be an additional update even before the october 1 deadline, so that is going to make it difficult to do that. there is also this contradiction in determining eligibility. candace and every state, they have got to look at a person's income -- kansas and every state, they have got to look at a person's income. inis hard to have confidence a situation where we have to verify income. there is a strong dichotomy that i think undermine a lot of confidence in the system. is dealing with the outreach by the federal government. to be setup ined

in order to know how the system and we just learned who are those navigators going to be just a few weeks ago, yet the system is still not able to go live today. not passed a number oflaws about the skill set regulators, partly because we did not have all the regulations that come down. also the issue of rates. it is going to be very expensive for us. have twong to only insurers. that is not more competition. that is less competition. you have more choices in medicaid. we have looked at the price issues, and it is going to be a challenge for people.

finally, i see this every day. we serve the uninsured. we have done that before. to do that in the future. this is not going to make health care more affordable. it sets up new bureaucracies. it does not make health care better. do a better job, and it is best left to the states. >> thank you for allowing me the opportunity to address the affordable care act and how it will affect my district. 400,000 southw ians to obtain health care. it is appalling officials continue to pursue efforts to

block them from receiving health care coverage. he is privileged to be an elected officials. he has never had to worry about having a doctor to see if he gets sick. what it comes to allowing hundreds of thousands to receive health care coverage, he does not offer alternatives to their plight. senate, iback to the am going to be facing this bill that will nullify obamacare. tothe chamber, we are going debate nullification in the south carolina senate.

the 1800's.t in it did not work then, and it is not working now. we are looking for solutions, not road locks. south carolinians will be left in the emergency room's or to suffer without care. room's are the most inefficient and expensive form of care. extending coverage can allow newly insured to be diagnosed and treated for basic human not require that do an emergency room. medical homes will allow dietntative care such as and holistic approach that leads to cost-effective health care. it is shameful for us to live in the greatest country in the world yet have our citizens face the threat of they groep see --

of bankruptcy because they get sick. by having this covered with comprehensive insurance, premiums should be lowered. whenok forward to a time all of our citizens can enjoy coverage. expandinge covered by medicaid and others through their employment. an inclusive approach that ians allow all south carolin to be covered. , theut extended coverage cost of treatment comes to taxpayers. once everyone is covered, medical calls -- costs can be more easily controlled, and premium rate should fall.

as more people have health care increases, the training of new providers will allow universities to grow. we can expect 44,000 new jobs .rom the full implementation the salaries will generate millions in annual earnings and ultimately new revenue for the state. this is in addition to the billions of dollars that will float back to the state from the federal government over the next six years. is 20%ol -- health care of our state's economy. employed 250ectors south carolinians. good paying jobs. it's a vital part of our

economic set her, and these cannot the outsourced. quite simply, south carolina needs to accept the benefits being extended to our citizens if for no other reason than that it is the right ink to do. >> attorney general wilson. right wing to do. >> attorney general wilson. -- right thing to do. cartwright mentioned i was under the governor. that is not accurate. i am independent lee elected. independently elected. mese quotes attributed by were not made by me. i am not in the implementation process. for thee as an advocate

consumers of south carolina. iter a combat tour in iraq, believe i am entitled to be on track. my testimony has everything to do with the first obligation of government. the security and safety of need to as well as the suspend implementation of the affordable care act until security risks are mitigated and deadlines are properly met. we are all on our way to fully implementing the affordable care act. important deadlines are being missed, and security concerns are being dismissed. administration is missing more than half the deadlines. in order to determine eligibility, let's create a data

hub that connects data from seven different agencies. the year centers confirm data hub complies with federal standards. however, the hub has not be -- hasdently verified not been independently verified. officials lowered previous saying, this year by let's make sure it is not a third world experience. when it goes live, it may not be third world experience, but it .s overflowing with information this information should be regarded as if it were gold at fort knox. they should be required to exceed protocols that have allowed the records of more than 20 million veterans to be andromised between 2010

2013. states are also victims of federal taxes. millionmillion -- 3.6 were put under wrist during a major security breach at the department of revenue. that is not our primary concern. last month letter -- last month letter was prompted by the fact groupss is not requiring to properly screen, train, or onduct background checks individuals who will be entering sensitive information into the data hub. they will receive $1.2 million .n grants it's like girls scouts selling cookies. difficult to help girl

scouts sell boxes of cookies than to become a health care navigator. while they require employees to complete background checks, there are no similar things for navigators. this applies to personal information. the only requirement for navigators is they complete 20 hours of online training, less than most states require for a drivers license. busy dialingare seniors and other consumers as they try to cash in on confusion over the affordable care act. last year the department issued a report on scams. the first obligation of government is to maintain security of our citizens. implementation

of this program puts us at risk scamse it is riddled with and ri baches. americans should not have to barter their privacy for health insurance. the affordable care act undermines a fundamental responsibility of the federal .overnment until they rectify this matter by safeguarding information, congress must suspend implementation of the aca. >> congressman jackson. >> members of this committee, i member of the house health and welfare committee on the budget -- the joint committee on the budget and appropriate it -- appropriation. the supreme court has stated what the law is regarding health

care. today continuously debating this law instead of working together to ensure this tolementation is beneficial all states and citizens of the united states. where almost 900,000 of louisiana's population is uninsured and the health care budget has been cut by two for fiveach year consecutive years, we cannot afford to decline any portion of the affordable care act. we have hospice care to take care of the problem, he said. who represents trustana's citizens, who us, i cannot in good conscious

-- conscience advocate for the appeal in funding of the affordable care act. i would fail and overwhelming number of constituencies in my state. they will neglect to mention that she and her department that reflectsport savings while offering health care to over 400,000 of our uninsured citizens, almost half of those uninsured. our independent office arrived at an even higher number in savings to louisiana and it citizens. almost $550 million. about thecomplaining difficulty of implementing this act.

they wasted countless time supporting measures we voted down which would have required us to take an oath of referendum by two thirds vote in order to enact any portion of the affordable health care act. spends over 600 million yearly, mainly through dollars we continually request through the federal government. we are one of the top five states who received these. independent reports reflect that the affordable health care act will save the federal government , and that is 50% the long-term savings. the immediate savings show approximately $500 million in savings.

louisiana's economy has suffered during these tough economic times. implementation offers 26.8 billion dollars in our state's economy and will create over 47,000 jobs in the state of louisiana. contribute greatly to a healthier, more productive workforce. the federal insurance exchange is to those paying insurance premiums by creating a more competitive market and driving down the cost of insurance for everyone. somewhere in louisiana and across our nation there are younger versions of you and ourselves who aspire to go to higher learning without having to worry about whether they will get insurance or not. the affordable health care act offers them access to the american dream by allowing them

to remain covered under their 's health insurance, who pay for those premiums. whoseare families children are sick parents who have been diagnosed with life- threatening conditions and have been told they have reached benefits.mum of i say to you our good conscience tells us we must respond to the affordabled health care act has done so, but if you do not believe me, a said whater once penn we do to the least of us we also due to him. it's time to do right. >> thank you for highlighting how the implementation of the affordable care act has

presented major problems for louisiana. i am the secretary of the andrtment of health hospitals in louisiana. i have served for over 25 years, working with individuals who have health villages and developmental disabilities. it's the affordable care act was signed into law, we have repeatedly shared our concerns with the law and its implementation. seen those fears become reality, and our decision to not establish a state-based exchange validate it. it is not surprising that many even the federal government are narrowing the scope of their exchange capabilities as we near the mandated launch. over the law was passed three years ago, much of the regulations have been issued in this past year, and they

continue to change. cms released in june what they claim to be the final version of guidance that will govern interactions between state medicaid programs. we have since learned new changes are forthcoming which will likely require significant reprogramming efforts for our system. critical questions often take three to four months for a response, wasting precious time and resources that easily could have been avoided and cannot the afforded -- cannot be afforded as we near deadlines. we also face confusing misinformation. we recently experienced confusion over whether pregnant c was considered a qualifying life event for women to enroll in the exchanges outside of the designated enrollment period. the federal government's website recently changed the definition

of a qualifying life event, removing the event of earring pregnant and now stated -- the event of being pregnant and now said it is the birth that counts. we have received multiple conflicting answers from officials. the screenshot illustrates this frustrating inconsistency. we are troubled with how they states.outreach with these groups have had barely a month and a half to prepare. there is almost no oversight or standards for how they will rip -- how they will work. we also have serious concerns about the call centers that will provide assistance. we learned a call center will be offered in a small town in

louisiana, but operations are only starting this month. employees will have less than a month of training before launch. we were alarmed to learn that a constituent who called the hotline was told many states are expanding eligibility. louisiana has publicly stated it will not expand medicaid eligibility. if the federal call center and toy these are not equipped with such basic information, how are they equipped to handle this program. we have also faced issues relating to the application for medicaid and the exchange. to relate the ability directly to the streamline application built at the federal level rather than to duplicate

at the state level. we were told each state was risk on civil for -- was responsible for its own implementation. we made multiple requests for the online application source for our contractor to verify louisiana's version. it was never provided to us. in march, federal officials promised to provide states with a solution to meet the newly mandated income standard for medicaid eligibility. however, we learned in a june conference call that we had the responsibility. we anticipate that it will take our contractor more than 5000 hours of work to meet all the related mandates for a total cost of $750,000. to frustrate matters further, we learned last week the federal solution was finally ready for too late to the useful. i have only highlighted our major concerns. we expect more problems to arise as october is just two weeks

away. while these faxed raised serious questions, we continue to believe the best solution for our nation and our state is that the entire lobby replaced and repealed, repealed and replaced with a more affordable or get driven solution that gives states the flexibility to design programs that best meet the needs of the individual population. thank you. good morning. germans have a ranking members chairmans,, ranking members, thank you for sending me an invitation to testify on the federal implementation of obamacare. concerns of state government -- i am excited to elucidate the problems we have encountered and address opposition to the implementation of the affordable care act. my name is eleanor sobel and i

represent the 33rd district in the florida senate. i was elected in 2008 and i service chairwoman of the florida senate children's families and elder affairs committee. i serve as vice chair of the ethics and elections committee as well as vice chair of the health policy committee and the senate select committee for affordable health care. predominantelmingly republican senate. i wish i could be here with better news telling you that the state legislature managed to put politics aside and expand coverage to millions of uninsured individuals. unfortunately, this is not the case. -- springssion session concluded with the legislature being unable to pass and unable to expand coverage. i am here to tell you that the state of florida is punishing its people by putting up roadblocks and barricades to

obtaining quality affordable accessible health care. the message florida's republican which youe sending, believe sound something like -- a is it leverage privilege, not a right. another message that is going forth, we are here to put up barricades and obstacles and create public chaos and misinformation all in the name of political warfare. the florida house senate governor and cabinet are divided. the senate wishes to move forward with obamacare. we came up with a bipartisan bill in a florida senate that was a public-private partnership that would cover 1.5 million as well as useda the $52 billion of money from the federal government to help

implement the program. treasurer has made the choice to work with secretary kathleen civilians. the house and cabinet are irrationally preventing the execution and implementation of a policy that the citizens of florida desperately require. florida has the second highest percentage of uninsured residents in the nation at 25.3%. the $5.2as rejected billion over a 10 year. -- a 10 yeareriod period. we will not go along with the senate's public-private expansion plan. -- rick scottspot often contradicts himself. he says he supports medicaid expansion by trying to defeat implementation of obamacare. mostt to focus on the two

important sandbag issues i have encountered in the implementation of affordable health care. sandbag number one. what is the best way to defeat a program and make sure no one knows about it or understand how it affects the well-being of its citizens? governor scott hasn't limited a policy that would prevent the department of health from carrying out much-needed education to the uninsured claiming that health care education will be violating laws. this is a desperate attempt to prevent access to those who need health insurance the most. sandbag number two. the florida legislature passed a bill that handcuffed the insurance commission and used state authority to negotiate lower rates for two years. affordable insurance is a key part of obamacare. , theugh florida has agreed

federal government can only will if rates are reasonable or unreasonable. we need the insurance commission to provide the lowest rate possible so people will sign up. hopefully tax credits will reduce costs. way to put aside florida's differences and move forward with the affordable care act. we must move forward with this very important act and rectify florida's a lyrical stalemate. thank you very much. >> good morning, chairman. thank you for inviting me tuesday with you today. my name is matt hudson. i represent district 80 in the

florida house of representatives. i chair the health appropriation subcommittee. national the conference of state legislatures have committee. i am also a florida realtor. remember when you bought your first home? you saved money, found a home you liked. what if your realtor handed you a contract and you had to review it and three pages were blank? when you questioned it, they said, trust me. none of you would have invested your money that way. i am positive that the citizens of florida expect their government to make well-informed decisions not based on federal promises like, trust me. that is exactly what the aca has forced us to do. what we do know doesn't look for a good. the aca will make our shortage even worse. it has led to skyrocketing premiums. it has cap states uninformed and puts consumers' privacy at risk.

it medicaid expansions threaten patients' health and taxpayers' bottom line. the aca will make our health workforce shortage even worse. by 2020, we will have a national shortage of more than 90,000 physicians and 1.2 million nurses. 13% of our about physician workforce is retiring in the next five years. short currently already 753 doctors in our 248 primary care crisis areas. a massive influx of government- subsidized health care recipients because of the aca's insurance exchanges and medicaid expansions will make things what first -- much worse. they will face longer wait times and worse access to specialty care. costs will obviously spike as the demand for limited healthcare services will dramatically increase.

the aca will drive patients' premiums higher. we were promised the aca would let us keep the plan we like and the doctors we trust. the premium increases resulting in a web of new regulations and mandates that an empty promise for millions. the florida office of insurance regulation projects that a small group of premiums will rise an average of between five percent and 40%. will these folks have to choose or non high premiums coverage at all? where is the promise in that? washington isn't providing answers about insurance exchanges or protecting citizens' privacy. we had questions that needed answering. these questions were included in a three-page letter from our house speaker and senate president to hhs. they did not respond until january. after our deadline.

the response was just three. a rigorous -- three brief paragraphs that did not answer our questions. based on the final rules, florida made the right decision in rejecting a state-based exchange. hhs'smeline and noncooperation made an informed decision process and possible. we know that the exchange applicants will have to hand over social security numbers, birth dates, tax returns and much more. all the information needed for identity theft. we took action. florida passed a law that required the registration of exchange navigators which included background screenings, disqualifications and penalties for improper actions. medicaid expansion is wrong for patients and taxpayers. medicaid is already a problem across the nation. access is limited and outcomes are poor. the only randomized controlled trial of medicaid ever conducted found no improvements in health

when compared to the uninsured. the federal government continues to push medicaid expansion in florida. we reject medicaid expansion because we know access problems will get much worse. it has been difficult to estimate true cost of expansion. fromorida, the costs range less than $30 billion over a 10 year. to nearly $55 billion. from $1.4ates went billion to 3.5 billion. these estimates assume that the federal government will keep its promises despite carrying $17 trillion in debt. states deserve answers to these questions. washington is notorious for passing laws and leaving states to figure out how to make them work. in the case of the aca, we deserve to have our concerns heard. thank you members of the committee for the opportunity to

talk today. i look forward to your questions. >> thank you to all of you for your testimony. we appreciate your participation in this. i seem to get a feeling we have two different views. is, one group is talking about the dream of what these benefits might someday do. if everything works. the other group is dealing with the reality on the ground of implementation and it is not the dream but what is currently right now. challenge dealing with this law am i to say the least. theementation is very often state to my employer and individual challenge. every individual has to figure out whether their employer has provided them qualified health care and determine what that

means or whether they qualify for a subsidy. if they guess wrong they will be penalized on their income tax. or if their dad works somewhere and they take out insurance think at the subsidy, if they will be penalized because they took some subsidy that their employer should have covered -- all of the convoluted mess that has become this. we cannot employer -- ignore employers like ibm. walgreens is on the front page of the newspaper. they did not shift their insurance because they thought it was the right time. they shifted it because they are dealing with the aca. as they continue to step up, we wish these would be addressed. there is the dream of what we hope it will be and the reality of what is on the grant. we have a responsibility to deal with the reality on the ground.

attorney general wilson, you wrote a letter august 14 with other attorneys general and asked specific questions to hhs. do you recall those questions? >> yes, i do. i have the letter here with me. i believe it was provided to members of the committee. >> we can have that in the record. >> our concerns -- i am not here today as an implementer. that is not my role as attorney general. i am here as an attorney for the state, the citizens, and as a consumer advocate. the questions we outlined in the screeningdealt with of navigators and personnel and monitoring of personnel. other areas of concern were who bears the liability. is it the exchange, the individual navigator? notice to consumers are

they going to get? fraud prevention and remedies was another area. we had questions about penalties as well as supplemental state regulations. what can states do without running a fellow of preemption issues? questions -- we sent this letter to hhs -- we are still waiting on an answer. no response at this point that i am aware of. governor, you seem to be a person trying to obstruct something that is going to help people and take care of people. of taking care of people for free. caring for the folks. $3400 inspeak of additional compliance cost in your office last week. millions of dollars around the country. , whatstion for you is could the state of kansas do to

take care of their people or have they already done something? >> this is not a simple answer. there is not one single answer. let me give you a couple of examples. the state of kansas unlike almost every other state, we have gone through an overhaul of our medicaid system. we did not throw anybody off our system. we did not cut rates. we saved $1 billion and are giving everybody three choices really didn't have choices before. in that process, we got additional services for people and are starting to look at long-term health care outcomes. in the legislature, we passed a bill that got rid of mandates so that people could have a choice on a more affordable insurance option. in the state of kansas, we have worked on this and a whole variety of areas. medical homes, clinics, working

on this and a very conference of way. >> so there are state solutions. >> absolutely. >> just to let everyone know, the five-minute time -- we have two different subcommittees together. i want to stick on the five- minute time for questioning. >> mr. chairman, thank you. i will abide by your timeframe as well. let me just say, i was very impressed to hear that the chairman of the full committee is of the opinion that we should be fixing the affordable care act, not repealing it. he is not here right now because last year, he was a cosponsor of hr two which was a bill to repeal the affordable care act. he has had a change of heart, it appears, based on his comments today. i am pleased to hear that.

let me start by asking each of you, do you receive health insurance as government employees through your state? just raise your hand if you do. so everyone except for the attorney general. i know why you receive it payugh tri-care because you $500 a year for health care. it is pretty remarkable. i am not going to yield. very few seconds in my opportunity and i think we are all going to be able to ask our questions. let me ask you this. the presentations that you have provided today, particularly the republican representatives, were pretty remarkable. they were elaborate, they were

footnoted and i am curious -- when were you asked by the committee to participate in this hearing? >> wednesday or thursday of last week. i think thursday. >> attorney general? >> a week or two ago. >> all right. secretary kliebert? thursday? representative hudson? >> made last week. >> pretty impressive that you have been able to put together those kinds of statements with footnotes. that is something i did when i was in college and i didn't do it very well. my question to you is, did any of you have any assistance, anyone help you develop your statements? >> actually, my staff are -- my

staffer and our staff were literally working on this at 130 in the morning. >> my staff and i repaired the marks. >> my staff is involved in implementation and involved in etiquette health as well as -- >> senator hudson. >> florida health policy staff. >> did any of them do this in conjunction with the american legislative exchange council? they are very similar. many of them drafted in a way that would suggest there was collaboration. >> no. >> no? >> no to my -- not to my knowledge. >> thank you. -- let me move forward and ask a couple of questions. bobby, the governor of louisiana

recently said -- let me see if i can get to it. it makeswe don't think any sense to implement obamacare in louisiana. we are going to do what we can to fight it. ms. jackson, in your opinion, is it a significant challenge to the aca implementation when the chief executive of a state is so strong-willed in their commitment and interest in not and lamenting the law of the land? >> it has been one of the most difficult challenges. every letter sent to the department of health and hospitals from any health and welfare committee member or legislature has been met with delay and sometimes we have been told that it was not part of the

public records request. it is all the so -- also difficult when you have a secretary who has only been there six months trying to implement a major privatizing of our program. along with attempting to obstruct the implementation. >> i thank you and my time has expired. >> thank you, chairman. let me start with the reason i asked the gentlelady to yield. you wore the uniform of our country and serve our nation. i believe you serve in combat is that correct, attorney general? we appreciate your service. the tanning governor, let me start with you. -- lieutenant governor, let me start with you. do you think it makes sense to delay the affordable care act? >> yes it does. >> you represent an entire state

as well. your job is to look out for consumers. ,ou have asked questions of hhs they have yet to answer you. do you think it makes sense to delay the affordable care act? >> from a security and privacy interest standpoint, i do. one other comment, i would like to know what plan allows me to play -- pay $500 per year. i pay nearly $200 per month. my wife wants to know how to get that plan. >> let me go to you, senator hutto. based on what you said in your testimony, you probably disagree with guys on either side of you. you think that the affordable care act should move forward and the law should go ahead and be fully implement it. is that correct? >> that is correct. >> let me ask you a couple of questions. was howard dean wrong when he said the independent payment advisory board is essentially a

health-care rationing body? think it is a rationing body. >> was james hoffa wrong when he said that this law is going to americanshurt working and fundamentally change the 40 hour work week. was he wrong? >> i think he was. >> was afl-cio wrong last week when they said, fix the bill or repeal the whole thing. were they wrong? >> yes. >> ok, was the senator who wrong whene the bill he referenced that this bill was a train wreck? >> that was taken out of context, but yes. --warren buffett yesterday most people would say a fairly sharp individual. was he wrong yesterday when he said we should scrap the entire bill? >> we have to fix the bill.

>> was he right or wrong? >> what i am saying is that we need to work together. >> the president's hometown said, delay the entire law. endorsed thene president both times he ran for office. were they wrong when they said delay the entire bill? >> that is their opinion. i think they were wrong. >> this is amazing. we need you up here more often. you are right and everyone else is wrong. does it make sense -- you still think this bill should be unlimited when a major employer announced last week that 11,000 employees would no longer be covered by their insurance. is that a good result? >> that is not good. >> united parcel service announced that 15,000 workers and their spouses would no longer be covered. is that a good thing?

let me turn to the attorney general. deal with protecting consumers in your state. when a company says, they offer a product and have a guarantee. someone purchases that product and the guarantee is not met. the consumer gets a chance to take the product back and get something new or get their money back. what we have here is a guarantee that if you like your insurance you will be able to keep it. i can name a whole bunch of companies who are now coming people that because of the offer to the care act, you will no theer be able to keep product you thought you were going to be able to keep. that, to me, is why we should delay it. the guarantee that the president said was going to be in place is no longer in place. would you agree? >> yes. >> i yield back. >> mr. cartwright. >> think you, mr. chairman. thank you to the witnesses who

came here to share your expertise and insight. an exciting time in america. october 1, time to start getting signed up for the health-care law and make sure we get the word out. care.gov, get right on there. it is a new dawn in america health care. i want to start with you, attorney general wilson. thank you for correcting my misstatement. you work with governor nikki haley, not under her. i appreciate that. also want to thank you for your military service. i don't care if you are democrat, republican, pro-or anti-aca, if you deliver military service like you did, you deserve the thanks of all of us. i want to expand on our discussion of governor nikki

haley. were you attempting to distance aboutlf from her remark the importance of defunding obamacare in congress? are you trying to get away from that remark? >> no, representative. i am trying to appear today -- i am an elected official but i am trying to where the lawyer had. i fought obamacare all the way to the supreme court. the supreme court agreed with the states. we lost the fight. if it is the law of the land, my job as the lawyer for the of southof south -- carolina is to make sure their information is protected. >> you are a prosecutor. you know what a yes or no question is. do you agree with governor haley when she says that everybody else in congress needs to defund obamacare? >> yes.

when you were engaged in the fight in the supreme court arguing that the aca is unconstitutional, is that commentmade the public comparing the aca to committing robbery? is that what you did that? >> i don't recall that comment. i don't dispute that i made it but i don't recall it. >> i want to switch over to you senator hutto. you made a comment that my -- was taken out of context. congressman jordan has not been bashful. talking about the train wreck, the full context was, senator baucus said that if the aca is not implemented properly, the way it is meant to be done, it could turn into a train wreck. is that your recollection?

>> absolutely. we need to work together to make sure it is fully implemented correctly. >> thank you, sir. i want to jump over to senator sobel. it is a pleasure to have you here. all the things you have done to help seniors and health care in florida. i want to remind everybody that senator sobel has been talked about by the south florida a strong voice and tell at he for education, health care issues and senior citizen'' services." welcome, nice to have you here the senator. you have heard about what we have been talking about here. this hearing is about challenging -- challenges facing aca implementation. it was reported that governor scott issued a directive banning navigators from operating on the grounds of county health departments in florida.

senator sobel, and your opinion was this move intended to obstruct implementation of the affordable care act? >> yes, i believe said. -- i believe so. these health departments have the kinds of people that actually need health care. they go to these health because they don't have a private physician. by not allowing them on the property -- some of these -- theyes are owned by worked out a compromise that they could work outside and sign people up. that is not good enough because you cannot get people who don't show up on that day but show up in the past. this is a tremendous group of people who desperately need health care and governor rick scott is denying them access and

information. >> thank you for that. i yield my time. >> thank you, chairman. , i heard your testimony. we have it is everything going next door, and other program of interest. -- a classified briefing going next door. another program of interest. you said this is the law of the land but you have an opinion that there are aspects of this howthat were defective in they did things. let me run you through one of them. under the act, currently my medicaid, the poorest recipients -- it is a 50-50 deal. federal government present 50% on medicaid. state pays 50%. under the a horrible care act, for the first three years, it is 100% paid for by the federal

taxpayer. afterwards, it goes to 90%. isn't it a legitimate concern of states that a promise to pay more for less poor people, less needy people at 90% while the more needy people are being inherentlyat 50% is unsustainable? in the acte bargain that we had to pass before we could read it created a situation in which some of these things are simply not believable. is that correct? >> that is correct. >> in your state, was in that one of the reasons the governor had concerns, that it is all going to be from the federal government for the first three years and after that, it is at the whim of congress? >> that is correct. of the recent release of 2400 private e-mails

-- percent of social security numbers even before the act was implemented, isn't that one of your concerns, that this highly personal information, the question of what your social security number is but whether you are being treated for venereal disease or you have a persistent illness of some sort or whether you are a diabetic. all of that is exactly the kind of information that you were charged to make sure is not becoming public. >> that is correct. >> the conversation about people coming into county health centers, isn't compliance making sure that only doctors and cleared medical professionals have access to this kind of information as to what uri or anyone else in the feeling -- is receiving?

have.t is a concern i >> these navigators will in fact be gathering exactly the information that hipa is supposed to prevent from going -- true? >> potentially true yes. i want to make sure we get it correct here. i think that the affordable care act currently will be a train wreck. it doesn't answer serious questions about cost and privacy. -- i want to make sure i am clear. there were problems when president obama came in that had not been addressed. rising cost of health care, a that causes- cliff people not to earn more than a certain amount. if you earn less than a certain amount in america, you have

maybe $40,000 worth of benefits that come to you. when you earn more, you lose those benefits. the affordable care act, in my opinion, exacerbates that more because of the nature of the testing. do i want to address the issue of cost of health care? absolutely. and anymake it clear member on the dais can get more information from our staff. we have been working on a change to make it compliant with the exchange systems that are envisioned in the affordable care act. we are responding to the two -- the reality of a law. don't confuse my votes repeatedly to repeal as either only wanting to repeal or somehow not being against the affordable care act. i believe that a bill that was

100% partisan, voted on without a single republican vote or real input, that was -- we had to pass it before we could read it. it has material flaws which are numerous. it is a bill that should be started over again. having said that, i appreciate our panel and i will continue to hear what you have to say. because the chairman of the ranking member is not here that i want to thank all the witnesses. all of you came here without the federal government paying you a dime. since you all came on your own dime, i would like to add a thank you. i yield back. thank you very much, mr. chairman. my first question is to mr. hudson. in your submitted testimony, you stated these provisions require insurance companies to accept all applicants. even if they wait until they get

sick before applying for coverage. the companies are now prohibited from charging premiums based on likely cost. is that accurate? >> yes. >> are you referring to the guaranteed issue and community rating provisions of the affordable care act? >> yes. >> tank you for clarifying that. personally, i can't understand why you would oppose these important protections in the affordable care act. a recent analysis estimates that between 50 million and 129 million nonelderly americans have some kind of pre-existing condition. without the guaranteed issue and community ratings protections, the pre-existing conditions would put them at risk of not being able to obtain health insurance if they are self- employed or experience some other change in life circumstances. story --e heard the

she was here earlier. the ranking member described it in his opening statement. it is illustrative of the importance of these consumer protections. due to a pre-existing condition, a heart condition that he -- she suffered from since 1990, ms. lowery has been unable to obtain health care coverage since 2005. her insurer rescinded her coverage and left her with a $50,000 medical bill. insurancele to obtain through a high-risk pool established by the affordable care act and was covered when she had a heart attack this past may. i am grateful for that. she is able to be here with us today. another question, in the state of florida, if summit he suffers a heart attack and does not have insurance, what is the likely scenario from that moment forward? i would assume that if somebody

has a heart attack and somebody witnesses, what is the likely scenario after that when the ambulance shows up and tries to some of the without insurance who has just had a heart attack? >> i would assume it would be the same in your great state of new mexico. >> i am from california. >> california, excuse me. another great state. they would try to revive that person to the best of their ability and transport that person to a hospital. in my state, that is primitively challenging as i have eight counties without hospitals. >> say that person were fortunate to arrive at a hospital and their condition was in fact -- they revive that person, that person has some kind of surgery. then there comes a big lift of expensive -- expenses. what would happen to that list of expenses when the person without insurance shows up at a hospital with a heart attack?

what happens with the bottom dollar of that expense? what would likely occur? would the state pick up some of the cost? what is the likely scenario? you are chairman -- when chairman are you committee of? >> it is the statehouse. >> ok. what would likely happen to that dollar amount? >> likely, what would happen is that patient would be treated, stabilized under your act and then sent home after they had been stabilized. the cost of the care could be incorporated under charity care to that particular hospital. it could be facilitated by dish funds or low income pool funds. point, they

affordable care act is trying to find a solution to all of those situations in the great state of florida and the great state of california and every state. what the affordable care act is trying to address, that is the overall cost and who will bear that cost at the end of the day. providing a system that is better than the system we have today. i know exactly what happens when that occurs. the person who had the heart attack does not bear the burden of that. the insurance companies in the state of florida or california do not bear the burden. it will be a taxpayer system that will bear that burden and .r a private or public hospital understand,eed to

is that the affordable care act is trying to transition into a appropriateis more for this great country to address the ills of all americans and the current system 50 million to 129 million out because they have pre- existing conditions. those people who don't have health care will end up in the system and cost american taxpayers even more. >> will the gentleman yield? >> time is expired. correctly,erstand the affordable care act which costs hundreds of billions of dollars of taxpayer money replaces the idea that taxpayers pay money. didn't you make the point that the taxpayer is going to pay it under the affordable care act involuntarily and the taxpayer is already paying it?

people are not failing to get care under the affordable care act. you simply have taxpayers paying for the insurance in addition to paying for somebody if they go to a hospital. >> that is not what i said. wethe end of the day, if limit the affordable care act properly, would we have is more americans with health care coverage and true access to health care unlike what we have today. thank you. full and limitation will still have americans not covered. >> thank you, mr. chairman. i am from georgia. this is my insurance commissioner up there on the wall. i couldn't tell if that was your the ranking member who put that up there. what i tell you will not surprise you at all. commissioner loves people and cares about people which is why he got involved in

public service. it is a constitutional office in our state. what he said there is, we talk about how to get coverage, how to get affordable care. he said obamacare is actually the problem. i have a high deductible medical savings account. my policy was outlawed by the president's health-care bill. i can afford to buy a more expensive policy but a lot of folks in georgia who relied on those high deductible policies can't. , what isnt to ask you it in the president's health- care bill that you like, that is valuable for your constituents back home, that you and your state with your governor, your legislature, your insurance commissioner, but you couldn't have done on your own if you thought it was the best plan for your state? what is it that you needed the

benevolence of the federal government for? what permission did you need from washington to implement some of these things that are going to pay off for your constituents back home? >> nothing. solutions are best where it is local. all of our states have different problems and different solutions. we have a number of solutions that we could do here. it is all of these regulations that are there. we would like to have the money in the state so that we could implement some things. there are so many strings attached that it really gets in the way of a lot of things that prevent us from getting better outcomes. >> senator, let me ask you. i went to school in south carolina. my understanding is the modest health care plan that i had in college is now outlawed as well. what is it that south carolina is going to benefit that you

couldn't have done with your governor? >> what we are looking forward to is not using the emergency room as the medical home for so many people. the money that we get from federal tax dollars is going to help us implement that. >> i talk about that regularly. i'm pretty sure we take a cut off the top. i am glad that folks see that as a glass half-full, that some of those dollars will come back. mr. attorney general, is there something going on in south carolina that you needed defense permission in order to implement? >> i am a strong federalist. i believe that problems can best be solved by the states with a few exceptions. i have the look at the numbers. it would have been cheaper for the federal government to cut a check to every american who didn't have insurance as opposed to creating this huge goliath of a bill.

>> that is the way my math looks did. in fairness, president clinton and newt gingrich came together in 1996 to solve these pre- existing problems for federally regulated plans. we said at that time, states are smart folks that have smart people running those programs. we won't get into their business. , we said let's leave it to the states, the states will love their constituents marvin we do. is there something that you were unable to do to serve your constituents that you needed our permission from washington to get done? >> if you heard any of my testimony today, i talked about our state's governor and the department of health and hospitals advocating for her -- for cutting hospice care. we couldn't provide hospice care. to the extent that we were trying to regulate interstate commerce -- the state of limited on their regulation of -- thatte commerce

argument has been made at the supreme court. >> so when you're thinking about what you can and can't do, you're saying you don't have enough money to get these things done. --'re counting on talking taxing other americans. >> not at all. what we count on is that the money we send to the federal government would be distributed in a manner that we can take care of our citizens just like other states. we do pay federal taxes. we are afforded or should be afforded our rightful share of those federal taxes. >> there is no question about that. i suspect that is something you both find bipartisan support on. is there something that louisiana needed the fed's tradition -- her mission to get done? is -- i believe several things. we have done a good job

providing uninsured care. we had a state charity system. we have changed that to a public-private partnership which has a limited it a two-tiered system. we don't use it emergency rooms as medical homes. people opportunities for to receive outpatient care as well as follow-up care after they have received inpatient care for every uninsured person in our state. that implementation of the affordable care act will be detrimental to those that we are trying to help in the long run. >> that is what we believe as well. i look forward to sharing our ideas with you all. i'm convinced if we have 50 different projects, we will find at least one that serves america. >> we would love to have flexible health care. we believe that we can do that within the system that we have.

>> thank you. >> thank you, mr. chairman. you would like to yield my time to the gentleman from pennsylvania. mr. cartwright. >> thank you. senator sobel, i want to return to you. you are from florida. i am from pennsylvania. in my commonwealth, we have a figure of uninsured citizens of almost 12%. comparison to the 25.3% uninsured in your state. ,bviously, in your position with your set of values, this is something that you have been worrying about, working on for many years. am i correct? >> yes. >> i want to follow-up.

senator sobel, do you believe that your governor is investing the resources necessary to ensure that florida residents have the information they need to enroll in affordable quality health care in the affordable care act exchanges? >> thank you very much for the very good question. i don't believe there has been used by thegeted or governor to inform people about the affordable care act. >> so we all know that getting on health care.gov is easy enough for young people, but you have some folks in florida that may not be as good with computers. they are the people that need us to go the extra mile to make sure they understand how to sign up. is the florida administration doing everything it needs to be

doing to help those people? >> the florida administration is not to my knowledge doing much or anything to educate the people about this program. i believe the best way to kill a is not to get the information out to the people who actually need that information. it has become a formidable task to make this program a success and have people get the health way that they need in a that they understand it. >> let's you and i give governor scott some help. tell us, what should governor scott be doing to ensure that implementation of aza, the law law goes smoothly. >> allow the navigators on the

premises. in theth the people health department. i also think that he should be weablishing a website -- might have one but nobody knows about it, telling people about the affordable care act. i believe that he should be speaking about it in his conferences, press conferences, as well as sending out information that it is now available. none of that is happening. >> switching gears for the moment, the rate review provisions in the aca require insurance companies to justify any proposed rate hike of 10% or more. savedear, this provision 6.8 million consumers in this country an estimated $1.2 billion in health insurance premiums. unfortunately, in florida the

legislature recently passed legislation stripping florida's insurance commissioner of the authority to review health insurance rate hikes. , myressman joe garcia colleagues, has called this move "a cynical attempt to undermine protections for florida's consumers in order to sabotage the implementation of the affordable care act." senator sobel, do you agree? >> yes, i do agree with the handcuffing of our insurance commissioner. at this particular time, he can of all, previously he could have negotiated the rates. right now, he can't say anything or do anything for the next two years. >> what is the point of doing this giveaway to health insurance companies? underlyingthe

premise here is that the rates will be so high that people will not sign up. you lose the affordable in the affordable care act. that is wrong. the insurance commissioner has indicated that there are tax credits to be had so the rates -- the 30%-40% rates that he is talking about of increase will be mitigated with the tax credits you will get for signing up. the headlines are 30%-40%. >> and it is misleading. thank you very much, senator. >> thank you, mr. chairman. mr. chairman, the committee has obtained an internal memorandum from may 28, 2013 detailing concerns about the ability to certify and register navigators and a sisters in the obamacare

consumer outreach program. the memo reads, we are becoming increasingly concerned about the ability of staff to authenticate, register and certify everyone who will be involved in the consumer assistance process. i would like to enter this memo and a record. later, another official decided tohat hhs leave the responsibility of certifying and registering to each navigator organization -- hhs rejected the action of creating a list of certified navigators and assisters. the lack of a list exposes consumers to significant risk since consumers that all the hhs hotline will be unable to verify if a person offering to provide them information about obamacare is working for legitimate organizations. that there is no

way for citizens in your state to contact hhs to verify if a person offering information about obamacare is working for a legitimate organization? >> that is a very troubling aspect. people want -- there is going to be a lot of confusion. we need good information and we need time to get good information and verify it. >> wilson? >> yes. kliebert?ry >> yes. >> mr. hudson, are you aware of a pole that was released last week that 60% of americans believe obamacare will harm their health care? 56% of democrats believe obamacare will harm their health care. are you familiar with that poll? >> yes, i have seen the

headlines. >> i have another question. to twist things around a little bit. you said you were a realtor. if i understand, a realtor's ,ob, you bring the customer in they are thinking about buying a home, you talk to them. , showok at the listings them the listings, maybe a photograph. yes, i have sold many homes. >> how about somebody that never walked into the home you sold? did they get to look at all the rooms? did you go in the basement? >> basements are a challenge for us. >> i understand. in michigan, we have basements. before a person buys a home, they get to walk in and go into each room, maybe test of the appliances, correct? >> yes. >> ok.

>> if i can add, i wouldn't sell a person a home if they didn't know what they were bargaining for. that is one of the largest investments in their life. doing so is reckless and inappropriate. >> before they buy that documents. you tell them what they are getting and what they are not getting, right? >> as well as a number of disclosures. >> you would lead your customers read the contract before they signed? correct? or at least have their attorney or representative read the contract, correct? >> you are absolutely correct. >> sinecure, you disagree with that? we should vote for

something that we did not have the opportunity to read. -- senator, you disagree with that? you think we should vote for something that we did not have the opportunity to read. >> i yield back my time, mr. chairman. >> i think we had 20 seconds or so. >> you mentioned before about conflicting messages. has that been resolved yet? are you still waiting for details. >> we are still waiting for details. our policy decisions, it affects how we will move forward. >> will the gentleman yield?

>> can you hold on for a moment? >> to the secretary, isn't the reason why there is not a willingness to allow someone to acquire insurance because we do not want people to gain the system and not access the insurance when the insurance is available to them and they choose instead to pay the tax? i am not sure in terms of the rationale. we want to know whether or not there is a qualifying condition. >> if everyone takes up the insurance, there would not be an issue about a life-changing event because we would already have insurance. if you chose not to take fee,ance and pay the $300

correct? >> correct. >> the point is an individual mandate is trying to make sure we all take personal responsibility. that is one of the precepts of the republican party, personal responsibility. we will provided health care opportunity for everyone to access health care. we will keep the cost down, but if you choose not to, you can pay a fee, which would mean that you are not going to access that health care. that is a choice. if you do become pregnant, you will be paying out-of-pocket. we want you to have prenatal care. if you are indigent, you will get re-natal care. if you are making $100,000 a year and you choose not to have

insurance and you get pregnant, you chose not to access it. that is why you are getting some question. >> we want a definite answer so we can move forward. they do not pay a fee. they pay a tax. i would asked unanimous consent that the extra one minutes and 10 seconds be extended to me. >> that was in response. >> my friend from georgia mentioned newt gingrich. do you happen to recall the reason the speaker of the house opposed the clinton health-care initiative?

the single most important reason he object to do the 1993 initiative, do you recall? mandate, a universal an individual mandate. was that a liberal tactic? >> things have been turned on their head. tanks a conservative think , and now it is socialism. you introduce them legislation in 2011 to prohibit a person from being compelled to purchase health insurance, is that correct? you just testified that as a realtor, you believe in disclosure so that a consumer is of the pitfalls of the potential purchase. when you introduced your bill,

did you happen to mention that it was modeled almost identically on something provided by -- page 12 of that mirrors your much legislation, are you aware of that? >> if you are referring to something called the health care freedom act -- a modelreferring to bill of page 12 of that brochure . i do not have the book in front of me. >> you were not aware that your legislation happens to mimic a --el bill is that your testimony under oath?

>> there are a number of pieces of legislation that are supported by a wide variety -- >> that was not my question. were you aware of the model on that almost identically mirrors the legislation you introduced? >> that is correct. i would like to finish my answer. >> this is my time, mr. hudson. did you reveal that to your colleagues? you just said how you committed -- you are committed to full disclosure. this came from their legislative initiative. >> when we had discussions on this, the term did come up. >> thank you.

about your view of states rights. has a long issue -- tradition about that issue. of yourerested philosophy on the law. when you lose in a legislative battle and something becomes law , and then you lose through the legal system, up to the supreme , do you think as attorney general, it is still ok to try to obstruct the implementation because you do not agree with it ? is that your legal philosophy? would you take issue with this gentleman, whoever he is, that that is not a very good legal strategy? >> you use obstruct very broadly. my concern is that a lot can be constitutional and still be bad policy.

i believe obamacare was unconstitutional and the supreme court disagreed with me. it does not negate the fact that it is still bad policy. we have a duty to continue to try to improve it. >> i could not agree with you more. of structure and -- obstruction is a different matter. >> the witness was responding to this question. i have been very careful on time. >> thank you, mr. chairman. does obamacare raise premiums in your state? does obamacare raise insurance premiums in your state?

we have not had the full release of what it does to premiums across the board and the federal government has not released the information for us, but we have an example, would we have gone to the website and all of the examples, it shows a dramatic increase. >> madam secretary? groups, up to 200%. we do not have all of the details. we do have data that indicates it will go up 200%. >> representative? we lack a tremendous amount of actuarial value to make discerning judgments. we can project and the projections are not good. >> lieutenant governor?

does obamacare reduce choices? >> absolutely. of plans that people can choose and also in the number of insurers that are in the exchange. >> madam secretary, same question. >> there will be four exchanges. in our medicaid plans, we now have five choices. in those instances, it would .educe some level of choice >> representative hudson? >> it will definitely reduce choice. >> what is the overall view of the citizens of your state with regard to obamacare? overwhelmingly against it. >> madam secretary? >> we have had several polls and

debates that indicate that overwhelmingly there is not a will to move with expansion. >> representative hudson? absolutelyns are opposed to it. ral areasareas -- ru are going to be disproportionately affected. almosts things impossible to implement. wilson,ney general question for you. oh, cares -- obamacare's implementation has problems, delays, higher insurance premiums, and greater burdens on business. how the law is impacting the city since -- impacting the citizens of your state?

the states ability to comply? is notpendently, it something i am qualified to comment on. it is my opinion that it will adversely affect the citizens. i am begging congress, if they want to criticize me and other folks who share my view, i welcome that. look at the questions we are asking as consumer advocates. we have a duty as elected officials to protect the citizens. >> lieutenant governor, could you describe the regulation process and now it is impacting

kansans as citizens and the government as well? but there are some issues of transparency. -- >> there are some issues of transparency. we are getting new software updates. we have a new software update coming sometime before october 1. even the navigators cannot be trained up to date on that. we are having to work overtime to try to comply. president,ing the after whom the bill is named, is the person who has done the most to delay implementation of obamacare, do you think it is appropriate to say that the obstruction is coming from outside the white house? >> no. i wish they could block a number of other areas as well. i would like to sq about the

important role the navigators will play in helping -- like to asked about the role the navigators hope lay. -- the navigators will play. talkedorney general about making government work. they came out because they wanted to take advantage of the law. law trained to look at the and uphold the law. according to a memorandum , navigatoris morning grant recipients will enroll 1.1 million uninsured people in the exchanges. 7.3 million people

through public education efforts about the benefits of the affordable care act. many of these organizations are experiencing the type of outreach necessary to get people enrolled in the exchanges. they have linked families in need with public and private benefits for which they are eligible. a number of people on the side of the aisle were against, but when it became the law, we did everything in our power to make sure our constituents were informed. the low income subsidy for the benefit. according to the memorandum, the privacy rejections and place in the navigator program. all grant recipients -- privacy projections -- protections in place in the navigator program.

the grantees have adopted additional privacy aboveces for their staff and beyond those required by the federal regulations and have a proven track record of responsibly handling sensitive data.al i think we can agree that implementing the affordable care act is a heavy lift. i am not saying there are not any legitimate privacy concerns. do you think that governor scott's decision to ban navigators from operating on the grounds of county health departments was a necessary or a remotely response? >> thank you for that very good question. roadblock,is a

overreacted. there are standards and lace from the affordable care act as well as florida having in place .riminal background checks i think this is an effort to stop people from enrolling. rightunfair, it is not and it hurts a lot of people who need the information. told my constituents, it is one thing to have opportunities and it is another thing to know about them. do you believe that this and many of the other regulations republican state officials and legislators across the country have imposed on navigators are motivated by the desire to delay

and obstruct enrollment in the exchanges? that this and many of the other regulations by republican state officials and legislators across the country imposed on navigators are motivated by the desire to delay and obstruct enrollment in the exchanges? , speakern conference boehner said this morning talking to the republicans, --ry member in this room attorney inticing the state of louisiana, i have seen so much obstruction, it reminds me the civil rights structures and the right to vote that was given to minorities.

in the louisiana, we have seen that example with the affordable health care act. thank you very much. i will be quick because i have a number of points. general, so that you know, on wednesday, september 11, 2013, the house committee on homeland security subcommittee on cyber security, infrastructure, protection and security technologies had a hearing on this very subject around the data hubs, where we are with implementation. you talked about deadlines not being met. those were responses that were provided by the auditor, who oversees this.

the result was the deadline was met. while we want to have talking points, the reality is different. attended a brain health trust in my district saturday. one thing that was made clear to me is there is more work to be done on the implementation of the affordable care act. necessary,h that is the education that is necessary, people need to understand this is about expanding care under medicaid and expanding benefits under medicare and adopting a new marketplace under the exchange. -- our governor happens to be a republican, who was part of the lawsuit with other states to challenge the constitutionality of the affordable health care act at

the time i served in the state directorre allowed is of health and human services to continue to work on the implementation of the bill until the outcome of the supreme court's determination. ,ecause he made that decision nevada is ahead of the mark on the moment station of our marketplace exchanges. they have agreed to expand medicaid, are navigators have been recruited and trained and are ready to do their job. this from a republican governor who did not agree with the law. he understood his job was to implement the law. .s it was adopted and upheld state, i have far too many constituents who will benefit under the affordable care act to

not see it implemented. is it perfect? no. does congress need to do its job to make the necessary adjustments? yes. i am glad to hear that mr. jordan shares my concern and on a concerns of labor provision of the bill that does need a congressional fix. i would asked him if he will join me in bringing forward legislation so that we can fix that and other provisions. senator, what happened to the millions of americans that now house coverage if the opponents are successful? they will not be successful. if they are successful, people could lose coverage. howepresentative jackson, would it affect your

constituents? >> we will be in the same boat ago.we were in a year to look forn solutions that really were not solutions. >> more than 32.5 million seniors have already received free preventative services because of the affordable care act. can you express to the subcommittee the importance of these services to your constituents? >> absolutely. if the bill is repealed, i believe there would be greater hardships for our seniors. it would be shameful to repeal any thought -- part of the

benefits that have already passed. >> mr. chairman, i know there are those on the other side you have different opinions about where we are with the affordable care act. after hearing for my constituents, small business owners, those in health care in my state, i believe it is time for us to stop having these theinual efforts to defund affordable care act and it is time for us to have congress do our job to implement it and move forward. i would use my home state of nevada as an example of how republicans and democrats, the governor, the legislature, and members of congress are working to do our job. >> thank you. let me say to attorney general wilson, i am very

grateful for your service to you this country. i was trying to make the point luxuryus have the great of having a government sponsored health insurance plan. the hope is for the 45 million americans who have no insurance whatsoever, the affordable care act will place them on equal status with all of us. let me also point out, there is a script that is being used that is not accurate. when people talk about the affordable care act that is costing us so much money, that could not be further from the truth. in fact, the very nonpartisan congressional budget office has $1.3that we will save trillion over the next two decades with the implementation

of the affordable care act. as a country, we spend 18% of our gross to mastic products on health care. -- gdp on health care. you might think, we get better health care. we do not. we rank 38 in the world health organization rankings of countries in terms of the quality of health care. we rank number one in spending and 38 and overall health care. the reference made by my good mr. jordan and by others on the other side of the aisle about the comment made i max baucus has been taken -- by max

baucus has been taken out of comment. i would like to point out what was really being said. millionre $554 requested by the president in his budget for promotion and advertising and education on behalf of the affordable care act. our good friends on the other side of the aisle chose to strike that funding completely and with that backdrop that senator baucus said, without promotion and out -- without education, there is going to be a train wreck relative to the implementation because people will not know about it. when we use the term train wreck, let's use it accurately as it reflects his comments. without comment i would like to point out that the handwringing going on here is all well and good.

1, there willer be six months in which people will have the opportunity to enroll. they will have the opportunity to enroll until march. lots of these kings shall be worked out during that. of time -- kinks will be worked out during that period of time. it will be better for all of us to not be the obstructionists. i would like to quote governor schneider from michigan. ,t is the law of the land upheld by the u.s. supreme court, and it is being implemented. some believe that fighting it is good politics. finding the way to make it work is good government. i yield back. >> i want to thank all of our witnesses for being here today. we are talking about our fellow

americans. we are talking about our brothers, sisters, neighbors. -- i was in mye district this weekend talking to some of my constituents. they are people who need this. i tell the story is about when we voted for the affordable care act. i got to the floor of the house for hours early. i sat on the front row. i had only one prayer. god, do not let me die before a vote for it. i knew it would save lives. i knew it would affect generations yet unborn. i knew it would allow some mother to be able to save her child. i knew would have a tremendous effect. we need to make it work. a lot of things are hard. we are america and we're better than that.

i am looking forward to all of you working with us. it is about trying to make it better. i would think the witnesses for coming. -- thank the witnesses for coming. you are the ones on the phone trying to be dancers writing letters, trying to get answers, dealing -- trying to get answers, writing letters, trying to get answers. in my state, we gathered all the state leaders last week. they had a long list of all of the unanswered questions. they got all the state leaders together and listen to questions and none of them had the answers. all of them assumed someone else knew that.

none of them knew what is going on. , this is going to be great, is very different when you have to implement. and when it is coming at you. the navigator a port dealing with the exposure areas -- report dealing with the exposure areas and the fraud. a lot of americans information is about to be exposed. as wehe navigators, and have seen the reduction of time required in their training, there are serious issues. in my district in central oklahoma, we have more advanced cancer care in oklahoma city

than in all of the united kingdom. we had a hospital opened in oklahoma city is a fee-based hospital. the canadian started coming for health care. their business are people from outside the country. sick, and they needed advanced care, they are coming here. the term medical tourism did not exist years ago. hospitals ininest the world are located right here. do we put that at risk by limiting reimbursements? we become equal with the rest of the world rather than leading the rest of the world in medical

innovation. we have to continue to press on. this is a billboard there are major problems. it is the law of the land -- this is a bill where there are major problems. there are major issues with implementing the law. almost every state is under a waiver, no one here is saying, we need to implement all of no child left behind. why? there are major problems with the law. we can see it based on how it is implemented. waivers have gone everywhere to free everyone up. seeing the same thing occur with the affordable care act. the problems continue to double on this.

the how sensitive are dealing with what do we do to replace no child left behind -- the house and the senate are dealing with what do we do to replace no child left behind? issues in somany many problems with the implementation, we have to look again at what we do to a place -- replace this. i look forward to the day when -- states are allowed to experiment. called insuregram oklahoma, which has been a fantastic program. to allow theg program to continue. is controlledre from washington, it is about numbers. when it is controlled from the state and local areas, it is about neighbors. it is about family and real lives. at the end of this day,

hopefully, we brought some questions to the table that we will get resolutions on. thank you for being here. we are adjourned. >> a couple of live events to tell you about tomorrow. the house oversight and government reform committee will be hearing on the attacks on benghazi, libya. the head of the international monetary fund speaks at the u.s. chamber of commerce. the republican senate committee on wednesday unveiled their version of health care reform. their proposal repeals the affordable care act and offers tax deductions so individuals can purchase insurance across state lines.

this is a 45 minute briefing. >> i want to thank everybody for coming. we are proud to officially unveil our health care bill, which is called the american health care reform act. this is a true alternative to obamacare. it is a bill we have been working on for months. when we started this process a few months ago, we have all been strongly opposed to obamacare, we continue to work on many different fronts to repeal, defund and delay obamacare, but we feel very strongly that we need to replace obamacare with market-based reforms.

both of those are worse under obamacare. i want to step through the point in our bill and have our members talk in more specific about it. we start by repealing obamacare. this is something that gives us a clean slate so that we can lay a new foundation and start addressing the problems. and lowermpetition health-care costs. we do that through a number of different means. we allow people to buy across state means -- state lines. throughs cannot do that -- for health care. if you can buy car insurance am a company in another state and still be able to drive in your state, you should be able to go. that is a lower cost for your family.

we allow small businesses to pool together and get the same buying power as a large corporation. not just for small businesses, but for families. something that helps increase competition and lower costs. one of the reasons that is the most attractive places your company can deduct those costs, the u.s. individual cannot deduct those costs. we level the playing field so an individual can deduct the cost of their health care if they find a better plan. something that increases

competition, but lowers the cost of health care. we put in place commonsense reform. frivolous lawsuits and the practice of defensive medicine. doctors tell me one of their big impediments to practicing is the threat of frivolous lawsuits. a third of all the tests they run are not tests they run for the health of their patients, but to defend against frivolous lawsuits. people do not like having to go get test after test. we expand health savings accounts.

we increased the limit so people can participate more actively. thatel very strongly someone with a pre-existing condition can be discriminated against in health care. wework with an existing -- put our money where our mouth is. we put up $25 billion in this build to up funds those high risk. so that someone with a pre- existing condition can buy health insurance at market rates. there are a lot of other things that can allow people with pre- existing conditions to be allowed to buy health care at lower cost. we put in strong protections. pro-life protections we fought for and many other pieces of legislation's to ensure taxpayer funds are not used for abortions. strong -- it will be

dr. price, dr. fleming, care have a great health working group that has worked really hard to put this bill together. i want to lead off by introducing the chairman, a medical doctor who has practiced medicine and understand all the issues. you do not have the government telling you what to do. >> thank you for being here. health careank our working group. what a great group this was and is. years oft together experience in health care, both in policy and practice. we had nurses, physicians, administrators, previous folks who worked in staff will --

legislature. one of the great disappointments i have had, i have been in congress for five years. i knew health care was going to be a huge issue in america. i came here to work on this issue. we were completely shut out of the debate four years ago when the affordable care act was debated. the problem with the system is not quality and not quantity. it is access and cost. i could see the cost of medicine was going up exponentially. it was forcing people out of being able to afford it. the premise of the affordable care act is one i wholeheartedly agree with. -- has notlogy is a done that. in theaising cost and end, with the exception of expanding medicaid, it may not

expand coverage to many people. the chairman said we need to have a market center bill that does not have any mandates in an , does not raise taxes, increases access and levels the playing field on the tax structure. one of the problems with our .ystem is how we got here i did not do a very good job of explaining pre-existing condition problems that occurred in the health care debate is going on. have a plan which covers 116 million of us in this country. you cannot have a pre-existing condition. we are talking about 17% of the population. complexl is enormously was about 17% of the population. we provided market-based solutions for this.

one of the most important things we did was to equalize the tax treatment for health insurance. let me use myself as an example. when i worked in practice as a physician, as one of the things in my practice was my health insurance was covered. run foretired to congress, the next day, i was treated differently. think about how many millions of people would benefit immediately if you treated them like a large company. us have to have some skin in the game if we are going to lower cost. expanding health savings accounts is one of the things we did to do that. things wea few of the will touch on some more things in a moment. of my introduce one colleagues and one of my good friends in congress and one of my colleagues in tennessee who

helped navigate the program in our state and who is a real expert. many of her ideas are in this bill. marsha blackburn. >> i want to thank the chairman, the leadership that they have brought to this process, i think they are invaluable. they are going to pay dividends for the american people. access and cost. constituents,to they are concerned about their access to health care, to the doctor. they do not want access to the queue, they want to know they are going to get the treatment they need at the time they need it. they want to make certain that this is affordable. we focused on those. he mentioned what we had in

tennessee. -- thishe experiment started in the mid-1990s. to help getgram was more people into the insurance pool. have them covered. --d of a mocker cause them kind of a microcosm on what we did on a national basis. what we learned was an incredibly expensive lesson. time you rolled the dice and you gambled on having those short-term expenditures or mandates lead you to long-term savings, guess what? it never happens. as we approached access and one of the provisions i

started working on shortly after i came to congress was opening up the insurance marketplace so that you could take down those signs at the state lines and allow people to buy whatever insurance product they wanted that met the needs of their families. indeed, that is embodied in this bill. it is something that will lower the cost for individuals. when you asked individuals without health insurance, why do not purchase insurance? the number one reason is the cost factor. along with an extended model helps to get that cost down and allows more people to opt into the insurance pool. we have that expertise from those who have worked in health care and we are so fortunate that renée came to us from north carolina as a nurse. she shares a republican women's policy committee and has been

such an important part of the initiative as we have worked on the obamacare replacement bill. thank you to everyone who is here for this very important rollout of the replacement plan. as we have gone through this process, we have listened to the american people. we understand what the american people need and want in their health care coverage. as we move closer and closer to the affordable care act, it is less accessible and more expensive and the promises that just simply us are not being met. it is so important for us to be implementing all of these different aspects into the plan of action that we have formulated. being in health care as long as i have been, i have listened to

the concerns of my patients i have taken care of. it is affordability, access to care, the fact that they feel they might not be able to get coverage. pre-existing conditions, a perfect example. if someone loses their health care coverage but has any number of pre-existing conditions, the thought of getting insurance was so astronomically expensive, a were not able to do it. we implement pre-existing conditions, assisting states whether high-risk pools so that we can bridge that gap and move toward a time when we will eliminate the issue of pre- existing conditions. ow best whatst -- kn their citizens need. we are empowering them with $25 million worth of high risk cost. it is a very important move.

as it is right now, if you are receiving va services, you cannot contribute to a health- care savings plan under obamacare. they will be empowered to do so. importantly, what this health care plan does, it is 181 places -- pages. it is a starting point. this is a starting conversation that we will be having with the american people on a good plan to not only help with health care coverage, but bringing down the cost of health care altogether. i have been so honored to be part of this working group. i want to introduce another member of the health care field. dr. john fleming from louisiana.

he has been so important to the contribution. thank you, renée. great to be here with you all. , i came tof us washington five years ago as a physician as well as a business owner who has to cover hundreds of people in their health insurance as well as my own family. i was quite distressed with were health care had led us to that point. we came here to reform health care. what was that we needed to reform? we sell the encroachment of government into health care making it less effective and more expensive. --came here to put into it

instead, we got obamacare. days, some couple of very good friends of president obama turned away from obamacare. said this,ett obamacare is a tapeworm on this nation's economy. what congress should have done was to lower the cost of care first and then try to expand it to others. instead, the government has taken over 1/6 of the economy. to expandtempted health care without doing a thing to lower costs. what is the result? you will have many more people cards, but no doctors

or hospitals. that is what we need to fix. one area that i have taken great health savings accounts and the expansion thereof. back about 2003, 2 thousand four, like all other business owners, i saw my employee costs going up. have heard of something called health savings accounts and i gathered all of my employees and i said, i will tell you my plan. instead of paying 15% increase in premium, we will keep the premium where it is by raising your deductible. i will take the difference and i will put it in your personal health savings account. we will do that year-over-year. i had a lady raised her hand and say, that is not going to work for me.

of my inhalers are more than what i will receive each month. i said, let me suggest that you stop smoking. the savings on your inhalers and the extra money i put in your , i think you will be net better off. i forgot about that exchange. three months later, she said, you are absolutely right. i am making a bunch of money. that is the way we save cost, to invest the individual patient into the savings. what do that, think of what that would do with the overall cost. we want to bring consumers back into it. we wanted to be market driven. one of which we have

transparency. health care providers compete on price and quality and consumers can make those valuable choices. that is the way folks will get health care costs down. savings accounts will go a long all in theus category of lower health care costs. i want to yield to my good friend for a few remarks. i want to thank my fellow members of the working group. i am one of the few members of this working group that has no professional health care experience. asked if iwhen i was was supposed to conduct recounts. we had very robust discussions

and they were positive ones and they were not unlike the same discussions that this nation is having around health care. bill is a good result of those discussions. in my role as secretary of state, one of the things i did a lot of was consumer protection. i was able to bring to the table some important points regarding consumer protection. in order to be a good consumer, in order to be a protected consumer, you have to have the power and the skill set to do those kinds of things. the other thing you have to have is good education. i do not mean formal education, but education as a consumer. you have to know what the prices are. you have to know all of the information. if you think about it, as

americans, we have very little information when it comes to the ability to make good health care decisions. for example, anyone of us could go down the street and know the tiresof the -- of four and make a value decision based on what we need. i do not believe it has to be any more complicated than that in health care. there will be certain emergencies that come up or we do not care what the prices. --price is. most of our transactions are not emergency related. we have not been allowed to apply the skill set that we have as americans. this bill does that. it kicks starts what we hope

will be a domino effect and price transparency. we require that medicare claims data be shared. now you can know what the prices doctors are charging. that information will drive the rest of the health care system and to price transparency. empowered with that information that we will be able to apply our skill set to our health care decisions and automatically and very quickly be able to drive down costs. that is what we mean by a free- market consumer driven approach. toh that, i would like introduce our last speaker, a good friend of mine. he is a health care provider in the state of arizona and the owner of the health care

providing organization. >> thank you very much. i am very happy that everybody showed up. i would like to thank steve for putting us together and empowering us to have our ideas come to the forefront. leadership is about empowering those sitting at the table to come up with solutions, debate, and defend what you're putting on the table. do you know who has been under government run health care the longest? native americans. years, a 30% of my patient base were native americans. they are providing free market standards.